Healthcare Provider Details

I. General information

NPI: 1811533516
Provider Name (Legal Business Name): DAYNA MOORE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 W 155TH ST
GARDENA CA
90247-4004
US

IV. Provider business mailing address

12003 AVALON BLVD STE 109
LOS ANGELES CA
90061-2859
US

V. Phone/Fax

Practice location:
  • Phone: 323-925-5447
  • Fax:
Mailing address:
  • Phone: 323-635-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number17023
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: