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General NPI Number Information
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NPI Number | 1891244695
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Entity Type | Individual
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Provider Name | SUMMER MOORE
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 2305 GENOA BUSINESS PARK DR STE 240
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City | BRIGHTON
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State | MI
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Zip | 48114-7005
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Country | US
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Telephone | 810-494-6820
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Fax | 810-229-0747
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | M600778066594
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License Number State | MI
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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 | 6801114695
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License Number State | MI
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