Provider Demographics
NPI:1881167799
Name:MOORER, KRISTINA RENEE (BA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RENEE
Last Name:MOORER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:GILMETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 FREEBOARD DR
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5039
Mailing Address - Country:US
Mailing Address - Phone:530-351-7975
Mailing Address - Fax:
Practice Address - Street 1:3120 FREEBOARD DR
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5039
Practice Address - Country:US
Practice Address - Phone:530-351-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health