Provider Demographics
NPI:1851089700
Name:MOSS, FAITH (CTRS)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 COPLEY DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5712
Mailing Address - Country:US
Mailing Address - Phone:804-855-4150
Mailing Address - Fax:
Practice Address - Street 1:8412 COPLEY DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-5712
Practice Address - Country:US
Practice Address - Phone:804-855-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA84335225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist