Provider Demographics
NPI:1699963074
Name:MOIR, JOHN BROWNLEE (BA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BROWNLEE
Last Name:MOIR
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22025 SPRINGBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336
Mailing Address - Country:US
Mailing Address - Phone:248-467-7447
Mailing Address - Fax:
Practice Address - Street 1:91 N. SAGINAW ST.
Practice Address - Street 2:SUITE G 101
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342
Practice Address - Country:US
Practice Address - Phone:248-253-0176
Practice Address - Fax:248-253-1570
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105017104100000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker