Provider Demographics
NPI:1619744745
Name:MOSS, AISLINN MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:AISLINN
Middle Name:MARIE
Last Name:MOSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5425
Mailing Address - Country:US
Mailing Address - Phone:301-792-4734
Mailing Address - Fax:
Practice Address - Street 1:1221 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2926
Practice Address - Country:US
Practice Address - Phone:571-478-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical