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Organization
MICHIGAN INSTITUTE FOR PREVENTION AND INTERVENTION
Active
Organization
MICHIGAN INSTITUTE FOR PREVENTION AND INTERVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKIE MOORE MA, LLP, LPC (OWNER)
(313) 883-7377
Entity
Organization
Contact information
Practice address
9851 HAMILTON AVE, DETROIT, MI 48202-1424
(313) 883-7377
(313) 883-3957
Mailing address
18530 MACK AVE STE 101, GROSSE POINTE FARMS, MI 48236-3254
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/12/2008
Last updated
11/12/2008
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