Provider Demographics
NPI:1689971806
Name:MOORE, DANIELLE COLLEEN DOHERTY (MS, LPC, BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:COLLEEN DOHERTY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1306
Mailing Address - Country:US
Mailing Address - Phone:804-553-3285
Mailing Address - Fax:
Practice Address - Street 1:8000 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1306
Practice Address - Country:US
Practice Address - Phone:804-553-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004938101YP2500X
VA0133000474103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992959928Medicaid