Provider Demographics
NPI:1821882432
Name:MOORE, ITHACA F (ASW)
Entity type:Individual
Prefix:
First Name:ITHACA
Middle Name:F
Last Name:MOORE
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:ITHACA
Other - Middle Name:
Other - Last Name:FINDS THE FEATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1375
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-1375
Mailing Address - Country:US
Mailing Address - Phone:707-671-2330
Mailing Address - Fax:
Practice Address - Street 1:6991 N STATE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9629
Practice Address - Country:US
Practice Address - Phone:707-671-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1272691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical