Healthcare Provider Details

I. General information

NPI: 1316079007
Provider Name (Legal Business Name): COLLEEN E MURPHY-MOORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 CUMBERLAND ROAD
NEW KENT VA
23124-2029
US

IV. Provider business mailing address

9407 CUMBERLAND ROAD
NEW KENT VA
23124-2029
US

V. Phone/Fax

Practice location:
  • Phone: 804-966-1657
  • Fax: 804-966-5639
Mailing address:
  • Phone: 804-966-1657
  • Fax: 804-966-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000674
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004338
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: