Provider Demographics
NPI:1184278566
Name:MOORE-SULLIVAN, ROBYN DIANE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:DIANE
Last Name:MOORE-SULLIVAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:DIANE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:3000 SE 164TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9314
Mailing Address - Country:US
Mailing Address - Phone:360-910-2038
Mailing Address - Fax:
Practice Address - Street 1:3000 SE 164TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9314
Practice Address - Country:US
Practice Address - Phone:360-910-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60629255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health