Provider Demographics
NPI:1518027465
Name:MOORE, DONNA RAE (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 CALIFORNIA AVE SW SUITE 101
Mailing Address - Street 2:WESTSIDE COUNSELING CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116
Mailing Address - Country:US
Mailing Address - Phone:206-933-8990
Mailing Address - Fax:206-937-3652
Practice Address - Street 1:4850 CALIFORNIA AVE SW SUITE 101
Practice Address - Street 2:WESTSIDE COUNSELING CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-933-8990
Practice Address - Fax:206-937-3652
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006433WASH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker