Provider Demographics
NPI:1659514842
Name:MOULDS, CHENEQUA TANEE' (EDS)
Entity Type:Individual
Prefix:
First Name:CHENEQUA
Middle Name:TANEE'
Last Name:MOULDS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CONSTANCE DR APT F
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1661
Mailing Address - Country:US
Mailing Address - Phone:757-515-3717
Mailing Address - Fax:
Practice Address - Street 1:228 N LYNNHAVEN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7514
Practice Address - Country:US
Practice Address - Phone:757-228-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling