Provider Demographics
NPI:1487932224
Name:MOORE MCCORMICK, ANDREA (LAADC, LMFT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:MOORE MCCORMICK
Suffix:
Gender:F
Credentials:LAADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CAMINO DEL REMEDIO STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1332
Mailing Address - Country:US
Mailing Address - Phone:805-884-6850
Mailing Address - Fax:805-692-5742
Practice Address - Street 1:315 CAMINO DEL REMEDIO STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-884-6850
Practice Address - Fax:805-692-5742
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133724106H00000X
CALCI12340518101YA0400X
CAIMF #93726106H00000X
CACATC-IV #132403101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)