Provider Demographics
NPI:1639883184
Name:GORE, DMOUCHELLE (LLPC)
Entity Type:Individual
Prefix:
First Name:DMOUCHELLE
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 MARTIN LUTHER KING JR BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2669
Mailing Address - Country:US
Mailing Address - Phone:313-770-1798
Mailing Address - Fax:
Practice Address - Street 1:626 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3513
Practice Address - Country:US
Practice Address - Phone:313-833-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451017171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional