Licia Monique Emanuel-Moffett, CDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

60811079 Issued in WA

Practice address

720 14TH Ave
Longview, WA 98632-2315

Phone

(360) 423-0203

Fax

(360) 423-5086

NPI assigned

Apr 24, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Licia Monique Emanuel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1184112294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322316",
            "telephone_number": "360-423-0203",
            "fax_number": "360-423-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322315",
            "telephone_number": "360-423-0203",
            "fax_number": "360-423-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMANUEL-MOFFETT",
        "first_name": "LICIA",
        "middle_name": "MONIQUE",
        "credential": "CDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60811079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LICIA",
            "last_name": "EMANUEL",
            "middle_name": "MONIQUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michele Ellis
• Sheila L Elting, LMP
• William J Elton, MD
• Matthew Elyea, PA-C
• Elysium Anesthesia, PLLC
• Leah Engebretson, ARNP
• Lacey Nicole Engelmann, LMP
• Courtney Michelle England, RN
• Breanne Enriquez, AA, SUDP
• Equilibrium Chiropractic, LLC

• Addiction (Substance Use Disorder) Counselor in Longview, WA
• Providers in Longview, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.