Provider Demographics
NPI:1629170139
Name:MOORE, VIVIAN BARBARA (LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:BARBARA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 ROLLING ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2837
Mailing Address - Country:US
Mailing Address - Phone:248-851-6284
Mailing Address - Fax:
Practice Address - Street 1:20600 EUREKA RD
Practice Address - Street 2:SUITE 819
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5343
Practice Address - Country:US
Practice Address - Phone:734-281-8282
Practice Address - Fax:734-281-0402
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health