MR. JACKIE MOORE (NPI# 1629355870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629355870 |
| Entity Type | Individual |
| Full Name | MR. JACKIE MOORE |
| Credential | MA |
| Practice Address |
18530 Mack Ave Ste 101 Grosse Pointe MI 48236-3254 |
| Practice Telephone | 3136739073 |
| Practice Fax Number | 3138848442 |
| Mailing Telephone | 3136739073 |
| Mailing Fax Number | 3138848442 |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
6401007537 | MI | Behavioral Health & Social Service Providers |
| N | 103TC1900X |
Psychologist Specialization: Counseling |
6301005272 | MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750632782 | Jackie Rena Moore | Psychologist | 5721 Oakwood St, Spencer, OK 73084-8638 | 2012-10-01 |
| 1710455159 | Jackie L Moore | Adult Companion | 8550 United Plaza Blvd Ste 702, Baton Rouge, LA 70809-0200 | 2018-11-04 |
| 1447746086 | Jackie Ray Moore | Counselor | 200 S Broad St Ste 7, New Orleans, LA 70119-6447 | 2018-07-06 |
| 1285767111 | Jackie Kaye Moore | Registered Nurse | 100 Blythewood Dr, Columbia, TN 38401-4828 | 2007-03-13 |
| Street Address |
18530 MACK AVE STE 101 |
| City | GROSSE POINTE |
| State | MI |
| Zip Code | 48236-3254 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434669 | Great-lakes Restorative Counseling, LLC | Counselor | 11800 Merriman Rd Unit 510896, Livonia, MI 48151-2075 | 2020-10-16 |
| 1386251841 | Diversified Community Services | Counselor | 10301 W 7 Mile Rd, Detroit, MI 48221-1962 | 2020-09-29 |
| 1891302717 | Paige J Welch | Counselor | 1509 Diamond Ave Ne, Grand Rapids, MI 49505-5217 | 2020-09-24 |
| 1588277040 | Gregory Dean Retzlaff | Counselor | 2043 Rowe Ave Ne, Grand Rapids, MI 49505-4238 | 2020-08-25 |
| 1336759539 | Embodied Wellness, Pllc | Counselor | 1354 Harvard Rd, Berkley, MI 48072 | 2020-08-03 |
| 1164030136 | Amina Mcclendon | Counselor | 22190 Avon Rd, Oak Park, MI 48237-2572 | 2020-07-16 |
| 1134747835 | Janita E Deal | Counselor | 503 Pearl St Ste 7, Ypsilanti, MI 48197-2615 | 2020-07-09 |
| 1376160168 | Scott Thomas Montgomery | Counselor | 1242 Baywood Cir, Brighton, MI 48116-6761 | 2020-06-29 |
| 1750907853 | Ronnie Stephen | Counselor | 15025 Fenkell St, Detroit, MI 48227-2647 | 2020-06-24 |
| 1043833643 | Ralph Cunningham | Counselor | 16057 Blue Star M Hwy, South Haven, MI 49090-9470 | 2020-05-19 |
| Find all providers with the same taxonomy | ||||
| City | GROSSE POINTE |
| Zip Code | 48236 |
Please comment or provide details below to improve the information on MR. JACKIE MOORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.