Healthcare Provider Details

I. General information

NPI: 1407426349
Provider Name (Legal Business Name): WILLMARA MOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 OLD COURTHOUSE RD
VIENNA VA
22182-3853
US

IV. Provider business mailing address

4506 BRIARWICK DR
NORTH CHESTERFIELD VA
23236-1022
US

V. Phone/Fax

Practice location:
  • Phone: 703-281-2657
  • Fax:
Mailing address:
  • Phone: 804-305-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: