Individual
DIANE M MOGA-ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSE, LCSW, LPC, CEAP
Contact information
Practice address
2733 S RIDGE RD, GREEN BAY, WI 54304-5513
(920) 497-6200
(920) 497-3135
Mailing address
W5488 QUARRY RD, APPLETON, WI 54913-9790
(920) 739-2212
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1849-125
WI
1041C0700X
Clinical Social Worker
3562-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39742500
—
WI
Enumeration date
01/31/2007
Last updated
09/11/2025
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