Provider Demographics
NPI:1932712999
Name:MCCONNELL, MOIRA (LPC, MA, NCC)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LPC, MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 PRINCESS ANNE ST STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3573
Mailing Address - Country:US
Mailing Address - Phone:434-207-2653
Mailing Address - Fax:
Practice Address - Street 1:1616 PRINCESS ANNE ST STE A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3573
Practice Address - Country:US
Practice Address - Phone:434-207-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275049084OtherNPI