Individual
MS. GENNEA NICKOLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
18303 E 10 MILE RD, ROSEVILLE, MI 48066-4988
(248) 469-9519
Mailing address
22524 SCHROEDER AVE, EASTPOINTE, MI 48021-4010
(248) 469-9519
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301013299
MI
103T00000X
Psychologist
Primary
6351000450
MI
103TC0700X
Clinical Psychologist
6301013299
MI
Other
Enumeration date
01/21/2009
Last updated
08/09/2022
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