Provider Demographics
NPI:1326827858
Name:MOYD, BRIEANNA JASMINE (M ED)
Entity Type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:JASMINE
Last Name:MOYD
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 CHANNING PL NE APT 412B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1770
Mailing Address - Country:US
Mailing Address - Phone:410-812-5434
Mailing Address - Fax:
Practice Address - Street 1:4250 MASSACHUSETTS AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5620
Practice Address - Country:US
Practice Address - Phone:202-803-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool