Provider Demographics
NPI:1619799657
Name:MOORE, SUSAN (LLMSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:NIEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 OKEMOS ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1224
Mailing Address - Country:US
Mailing Address - Phone:175-833-8100
Mailing Address - Fax:
Practice Address - Street 1:6211 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4665
Practice Address - Country:US
Practice Address - Phone:810-237-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)