Healthcare Provider Details

I. General information

NPI: 1417851288
Provider Name (Legal Business Name): ROBERT ANDREW MOOREHEAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 FORT DAVIS ST SE APT 201
WASHINGTON DC
20020-1338
US

IV. Provider business mailing address

2042 FORT DAVIS ST SE APT 201
WASHINGTON DC
20020-1338
US

V. Phone/Fax

Practice location:
  • Phone: 187-765-9450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number5200181
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: