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General NPI Number Information
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NPI Number | 1174147409
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Entity Type | Individual
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Provider Name | ANDREA MOORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 428 DELA VINA AVE APT 212
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City | MONTEREY
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State | CA
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Zip | 93940-3933
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Country | US
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Telephone | 831-455-5244
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | MONTEREY
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State | CA
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Zip | 93942-0444
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Country | US
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Telephone | 831-455-5244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 23032
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License Number State |
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