Provider Demographics
NPI:1295954907
Name:MOIR, BARBARA LUCILLE (MS)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LUCILLE
Last Name:MOIR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41617 CHATTMAN ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4228
Mailing Address - Country:US
Mailing Address - Phone:248-305-9306
Mailing Address - Fax:
Practice Address - Street 1:1 FORD PL
Practice Address - Street 2:1-E
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-876-2526
Practice Address - Fax:313-876-2279
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical