Healthcare Provider Details

I. General information

NPI: 1841161221
Provider Name (Legal Business Name): ANTUANE RAMON MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 30TH ST
RICHMOND VA
23223-6638
US

IV. Provider business mailing address

5146 SNEAD RD
RICHMOND VA
23224-6031
US

V. Phone/Fax

Practice location:
  • Phone: 804-426-6163
  • Fax:
Mailing address:
  • Phone: 804-745-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: