Provider Demographics
NPI:1285250258
Name:RAY, RHIANNA MOON
Entity type:Individual
Prefix:
First Name:RHIANNA
Middle Name:MOON
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RHIANNA
Other - Middle Name:MOON
Other - Last Name:RAY - FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 MEREDITH CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1636
Mailing Address - Country:US
Mailing Address - Phone:925-407-5873
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7930
Practice Address - Country:US
Practice Address - Phone:925-407-5873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist