Provider Demographics
NPI:1154976835
Name:MOORE, DARIEN
Entity type:Individual
Prefix:
First Name:DARIEN
Middle Name:
Last Name:MOORE
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 1:5011 NW 33RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5984
Mailing Address - Country:US
Mailing Address - Phone:904-263-8969
Mailing Address - Fax:
Practice Address - Street 1:2035 SW 75TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-3425
Practice Address - Country:US
Practice Address - Phone:352-332-8588
Practice Address - Fax:352-332-8589
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician