Provider Demographics
NPI:1174942288
Name:MOSS, MARTINA GINA (CADCI)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:GINA
Last Name:MOSS
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:GINA
Other - Last Name:KLIMENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 S. MAIN ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447
Mailing Address - Country:US
Mailing Address - Phone:775-463-6597
Mailing Address - Fax:775-463-6598
Practice Address - Street 1:1080 S. HWY 95A
Practice Address - Street 2:UNIT D
Practice Address - City:SILVER SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89429
Practice Address - Country:US
Practice Address - Phone:775-577-4633
Practice Address - Fax:775-577-9937
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01386101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)