Healthcare Provider Details

I. General information

NPI: 1750820981
Provider Name (Legal Business Name): TORI MOODY BS, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HALLWOOD FARMS DR
RICHMOND VA
23223-2648
US

IV. Provider business mailing address

705 HALLWOOD FARMS DR
RICHMOND VA
23223-2648
US

V. Phone/Fax

Practice location:
  • Phone: 804-683-5972
  • Fax:
Mailing address:
  • Phone: 804-683-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number464525128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: