Provider Demographics
NPI:1376251793
Name:MOORE, DAVIDA
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 FORT MCKAY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97462-8730
Mailing Address - Country:US
Mailing Address - Phone:541-214-2011
Mailing Address - Fax:
Practice Address - Street 1:1445 WILLAMETTE ST STE 6
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4087
Practice Address - Country:US
Practice Address - Phone:541-214-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist