Provider Demographics
NPI:1710524160
Name:MOORE, KASTINA RAE
Entity Type:Individual
Prefix:
First Name:KASTINA
Middle Name:RAE
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 1:2049 RIVERSIDE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1767
Mailing Address - Country:US
Mailing Address - Phone:805-769-5523
Mailing Address - Fax:
Practice Address - Street 1:2000 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-1523
Practice Address - Country:US
Practice Address - Phone:805-464-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor