Provider Demographics
NPI:1952921165
Name:HERRINGTON-MOXON, ROSALIND LATRICE
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:LATRICE
Last Name:HERRINGTON-MOXON
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 1:1460 BRITTANY LN NE APT H204
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4712
Mailing Address - Country:US
Mailing Address - Phone:310-531-4243
Mailing Address - Fax:
Practice Address - Street 1:1460 BRITTANY LN NE APT H204
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4712
Practice Address - Country:US
Practice Address - Phone:310-531-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)