Provider Demographics
NPI:1477746345
Name:MOSS, JON HUGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:HUGH
Last Name:MOSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 FITZHUGH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3540
Mailing Address - Country:US
Mailing Address - Phone:804-355-2899
Mailing Address - Fax:804-355-2971
Practice Address - Street 1:4913 FITZHUGH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3540
Practice Address - Country:US
Practice Address - Phone:804-355-2899
Practice Address - Fax:804-355-2971
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical