Provider Demographics
NPI:1396316162
Name:MOSS, RAYMEKA TIONI (LPCC)
Entity type:Individual
Prefix:
First Name:RAYMEKA
Middle Name:TIONI
Last Name:MOSS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ALICANTE AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5978
Mailing Address - Country:US
Mailing Address - Phone:949-381-8995
Mailing Address - Fax:
Practice Address - Street 1:2070 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1127
Practice Address - Country:US
Practice Address - Phone:949-508-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18052101YP2500X
CAAPCC10170101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health