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General NPI Number Information
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NPI Number | 1235825571
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Entity Type | Individual
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Provider Name | NONA MOORE
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 27085 GRATIOT AVE STE 107
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City | ROSEVILLE
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State | MI
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Zip | 48066-2984
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Country | US
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Telephone | 586-285-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 23830 SARAVILLA DR APT 6
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-3174
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Country | US
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Telephone | 313-773-4625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MI
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