Provider Demographics
NPI:1811533516
Name:MOORE, DAYNA (LPCC)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:MOORE
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 1:12003 AVALON BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2859
Mailing Address - Country:US
Mailing Address - Phone:323-635-8646
Mailing Address - Fax:
Practice Address - Street 1:1346 W 155TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4004
Practice Address - Country:US
Practice Address - Phone:323-925-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CALPCC101YP2500X
CAAPCC7302171M00000X
CALPCC17203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator