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General NPI Number Information
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NPI Number | 1871794917
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Entity Type | Individual
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Provider Name | LATONYA RAYETTE MOORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 18103 WOODINGHAM DR
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City | DETROIT
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State | MI
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Zip | 48221-2560
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Country | US
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Telephone | 980-365-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 18103 WOODINGHAM DR
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City | DETROIT
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State | MI
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Zip | 48221-2560
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Country | US
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Telephone | 980-365-9933
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004849
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC302977
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10601
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010540
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801117567
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License Number State | MI
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