Provider Demographics
NPI:1437762929
Name:MOORE, ED TANIQUA CAPRICE
Entity Type:Individual
Prefix:
First Name:ED TANIQUA
Middle Name:CAPRICE
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 1:1306 AMBERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8075
Mailing Address - Country:US
Mailing Address - Phone:510-230-5383
Mailing Address - Fax:
Practice Address - Street 1:2280 DIAMOND BLVD STE 500
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5719
Practice Address - Country:US
Practice Address - Phone:925-483-2223
Practice Address - Fax:925-826-5878
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health