Healthcare Provider Details

I. General information

NPI: 1487932224
Provider Name (Legal Business Name): ANDREA MOORE MCCORMICK LAADC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMINO DEL REMEDIO STE B
SANTA BARBARA CA
93110-1332
US

IV. Provider business mailing address

315 CAMINO DEL REMEDIO STE B
SANTA BARBARA CA
93110-1332
US

V. Phone/Fax

Practice location:
  • Phone: 805-884-6850
  • Fax: 805-692-5742
Mailing address:
  • Phone: 805-884-6850
  • Fax: 805-692-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCI12340518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: