Provider Demographics
NPI:1245761378
Name:MOORE, GAIL (CP00004745)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CP00004745
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9930 EVERGREEN WAY
Mailing Address - Street 2:BUILDING Z150
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3883
Mailing Address - Country:US
Mailing Address - Phone:425-347-5121
Mailing Address - Fax:425-353-6425
Practice Address - Street 1:9930 EVERGREEN WAY
Practice Address - Street 2:BUILDING Z150
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3883
Practice Address - Country:US
Practice Address - Phone:425-347-5121
Practice Address - Fax:425-353-6425
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WACP 00004745101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)