Provider Demographics
NPI:1750820981
Name:MOODY, TORI (BS, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:TORI
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:BS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 HALLWOOD FARMS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2648
Mailing Address - Country:US
Mailing Address - Phone:804-683-5972
Mailing Address - Fax:
Practice Address - Street 1:705 HALLWOOD FARMS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2648
Practice Address - Country:US
Practice Address - Phone:804-683-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA464525128172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver