Provider Demographics
NPI:1669620217
Name:MOORE, VIRGINIA JONES (LPC, PSYD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JONES
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3521
Mailing Address - Country:US
Mailing Address - Phone:703-408-2594
Mailing Address - Fax:
Practice Address - Street 1:6862 ELM ST
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3897
Practice Address - Country:US
Practice Address - Phone:703-550-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701002276OtherLICENSE