Individual
MR. DERRICK MICHAEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1500 E. WOODROW WILSON DR., JACKSON, MS 39216-5199
(601) 362-4471
(601) 368-4093
Mailing address
5354 KEELE ST, JACKSON, MS 39206-4106
(601) 454-2080
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C6782
MS
Other
Enumeration date
01/22/2007
Last updated
11/27/2024
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