Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301012109 | MI |
NPI | 1598919995 |
---|---|
Provider Name | Michael Joseph Mooney |
First Address | Roseville, MI 48066-4885 |
Second Address | Roseville, MI 48066-4885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 11/11/2008 |