Provider Demographics
NPI:1558321596
Name:MOORE, SARA ALICE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ALICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601882
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95860-1882
Mailing Address - Country:US
Mailing Address - Phone:916-595-8812
Mailing Address - Fax:916-481-4272
Practice Address - Street 1:2701 COTTAGE WAY
Practice Address - Street 2:SUITE 19
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1225
Practice Address - Country:US
Practice Address - Phone:916-595-8812
Practice Address - Fax:916-481-4272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health