Provider Demographics
NPI:1700366846
Name:MOORE, ERIN K (CCAPP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 SFD BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1840
Mailing Address - Country:US
Mailing Address - Phone:415-489-8009
Mailing Address - Fax:
Practice Address - Street 1:710 C ST STE 8
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3853
Practice Address - Country:US
Practice Address - Phone:415-485-6736
Practice Address - Fax:415-236-1830
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R1319150818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)