Healthcare Provider Details

I. General information

NPI: 1992872162
Provider Name (Legal Business Name): CECIL JOSEPH MOIX MSW LCSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 CIVIC CENTER DRIVE NORTHLAND CLINIC SUITE #303
SOUTHFIELD MI
48076-4169
US

IV. Provider business mailing address

20300 CIVIC CENTER DRIVE NORTHAND CLINIC SUITE #303
SOUTHFIELD MI
48076-4169
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-8190
  • Fax: 248-559-8776
Mailing address:
  • Phone: 248-559-8190
  • Fax: 248-559-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801004117
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: