Provider Demographics
NPI:1629216056
Name:MORAGA, IRMA (CADC-II,ICADC)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:MORAGA
Suffix:
Gender:F
Credentials:CADC-II,ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2500
Mailing Address - Country:US
Mailing Address - Phone:916-434-8927
Mailing Address - Fax:916-434-0678
Practice Address - Street 1:1530 3RD ST STE 106
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648
Practice Address - Country:US
Practice Address - Phone:916-434-8927
Practice Address - Fax:916-434-0678
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA020050815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)