Healthcare Provider Details

I. General information

NPI: 1073439113
Provider Name (Legal Business Name): MS. LESA AALIYAH MOUZON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 HARRIET TUBMAN LN
COLUMBIA MD
21044-4015
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 1
COLUMBIA MD
21046-3419
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 888-344-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: