Healthcare Provider Details

I. General information

NPI: 1932471281
Provider Name (Legal Business Name): MRS. LINELL C MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22170 W 9ML
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

22170 W 9ML RD
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-372-6800
  • Fax: 248-355-1402
Mailing address:
  • Phone: 248-372-6800
  • Fax: 248-355-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: