Healthcare Provider Details

I. General information

NPI: 1912728882
Provider Name (Legal Business Name): SETH MORAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 CONSTITUTION DR
VIRGINIA BEACH VA
23462-6722
US

IV. Provider business mailing address

1001 BISHOP ST STE 2685A
HONOLULU HI
96813-3404
US

V. Phone/Fax

Practice location:
  • Phone: 757-262-3316
  • Fax:
Mailing address:
  • Phone: 310-739-4694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: