Individual
PATRICIA ANN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
200 LILLY RD NE STE C, OLYMPIA, WA 98506-5080
(360) 918-8336
(360) 972-2152
Mailing address
200 LILLY RD NE, OLYMPIA, WA 98506-5427
(360) 918-8336
(360) 972-2152
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60119738
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2115178
—
WA
Enumeration date
05/28/2010
Last updated
03/26/2021
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