Basic Information
| Provider Information | |||||||||
| NPI: | 1295954907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOIR | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | LUCILLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41617 CHATTMAN ST | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483754228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483059306 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 FORD PL | ||||||||
| Address2: | 1-E | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138762526 | ||||||||
| FaxNumber: | 3138762279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301005823 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.