Provider Demographics
NPI:1376817049
Name:MOSS, VICTOR MORGAN JR (EDS,LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MORGAN
Last Name:MOSS
Suffix:JR
Gender:M
Credentials:EDS,LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2133
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2133
Mailing Address - Country:US
Mailing Address - Phone:804-210-1104
Mailing Address - Fax:804-210-1105
Practice Address - Street 1:6810 TEAGLE LANE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061
Practice Address - Country:US
Practice Address - Phone:804-210-1104
Practice Address - Fax:804-210-1105
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
VA0701001495101YP2500X
VA0717000752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist