Provider Demographics
NPI:1578085189
Name:DAVIS-MOORE, TAMIKA LEE (LLP)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:LEE
Last Name:DAVIS-MOORE
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1781
Mailing Address - Country:US
Mailing Address - Phone:313-629-8600
Mailing Address - Fax:
Practice Address - Street 1:7800 W OUTER DR STE LL30
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3461
Practice Address - Country:US
Practice Address - Phone:248-299-0030
Practice Address - Fax:248-299-0030
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361008018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical