Provider Demographics
NPI:1861645053
Name:MOORE, DARLENE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
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 1:733 E CHAPMAN AVE
Mailing Address - Street 2:06
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3805
Mailing Address - Country:US
Mailing Address - Phone:714-326-6476
Mailing Address - Fax:714-828-1456
Practice Address - Street 1:733 E CHAPMAN AVE
Practice Address - Street 2:6
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3805
Practice Address - Country:US
Practice Address - Phone:714-326-6476
Practice Address - Fax:714-828-1456
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 33866106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist