Provider Demographics
NPI:1588703334
Name:MOORE, TERRI DENISE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 BRILLIANCE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4084
Mailing Address - Country:US
Mailing Address - Phone:248-299-9170
Mailing Address - Fax:
Practice Address - Street 1:121 S BARNARD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2939
Practice Address - Country:US
Practice Address - Phone:810-559-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010688681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical