Individual
MS. AMANDA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
634 PRESSLEY ST, SANTA ROSA, CA 95404-5526
(707) 573-6955
Mailing address
1103 SUNNYVALE CT, SANTA ROSA, CA 95401-4445
(707) 228-3225
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1954
MEDI-CAL
CA
Enumeration date
10/16/2015
Last updated
10/16/2015
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