| NPI | 1760649628 |
|---|---|
| Former Name | MICHELLE GLYNISE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150107720) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149027689) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2025-07-15 |