Provider Demographics
NPI:1770753360
Name:MOORE, BOBBYE JEAN (CATC)
Entity type:Individual
Prefix:
First Name:BOBBYE
Middle Name:JEAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 SPARROW LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2429
Mailing Address - Country:US
Mailing Address - Phone:707-718-6027
Mailing Address - Fax:707-759-4515
Practice Address - Street 1:2290 DIAMOND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5742
Practice Address - Country:US
Practice Address - Phone:925-798-7250
Practice Address - Fax:925-798-3359
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM1007281844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4838OtherDRUG MEDICAL