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Individual
THERESA MARIE CALLARD-MOORE
Active
Individual
THERESA MARIE CALLARD-MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D, MSW, ACSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149.023242
IL
1041C0700X
Clinical Social Worker
6801067098
MI
1041C0700X
Clinical Social Worker
Primary
S.2309783
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8008976950
BLUE CROSS
MI
01
—
820555231
SHANTI COUNSELING TAX ID
MI
Enumeration date
07/18/2006
Last updated
10/15/2023
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