Provider Demographics
NPI:1548283138
Name:MOSES, MELISSA GAIL
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GAIL
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:GAIL
Other - Last Name:GOODING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1022 FRIENZA AVE # A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-2525
Mailing Address - Country:US
Mailing Address - Phone:916-854-4564
Mailing Address - Fax:916-857-1580
Practice Address - Street 1:3353 BRADSHAW RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2607
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:916-857-1580
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340064AP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)