Provider Demographics
NPI:1699257766
Name:MOORE, ANGELA CHARICE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHARICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4581 S LAPEER RD STE F
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2415
Mailing Address - Country:US
Mailing Address - Phone:248-309-3464
Mailing Address - Fax:
Practice Address - Street 1:4581 S LAPEER RD STE F
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2415
Practice Address - Country:US
Practice Address - Phone:248-309-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health