Individual
MS. CARRIE L MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMSW, CAAC
Contact information
Practice address
157 S KALAMAZOO MALL, 250, KALAMAZOO, MI 49007-4877
(269) 383-1440
(269) 383-9781
Mailing address
1110 COBB AVE, KALAMAZOO, MI 49007-2450
(269) 349-7148
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C-02372
MI
101YM0800X
Mental Health Counselor
Primary
6801062534
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801062534
LMSW
MI
01
—
C-02372
CAAC
MI
Enumeration date
06/08/2006
Last updated
04/21/2010
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