Individual
DAMON MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15450 E JEFFERSON AVE STE 180, GROSSE POINTE PARK, MI 48230-2031
(313) 444-4393
Mailing address
25898 CHIPPENDALE CT APT A, ROSEVILLE, MI 48066-3975
(810) 937-9137
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009236
MI
103TS0200X
School Psychologist
PP0000001037037
MI
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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