Healthcare Provider Details

I. General information

NPI: 1427730464
Provider Name (Legal Business Name): THE FOX MOON FARM PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 OWENS MILL RD
SAINT STEPHENS CHURCH VA
23148-2319
US

IV. Provider business mailing address

6450 OWENS MILL RD
SAINT STEPHENS CHURCH VA
23148-2319
US

V. Phone/Fax

Practice location:
  • Phone: 301-653-8539
  • Fax:
Mailing address:
  • Phone: 301-653-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CINDY FREISHTAT
Title or Position: CO-DIRECTOR
Credential:
Phone: 301-653-8539