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Individual
MR. JACKIE MOORE
Active
Individual
MR. JACKIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6401007537
MI
103TC1900X
Counseling Psychologist
6301005272
MI
Other
Enumeration date
11/15/2011
Last updated
11/15/2011
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