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General NPI Number Information
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NPI Number | 1104632454
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Entity Type | Individual
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Provider Name | CAROLINA ANDREA MORA
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Gender | Female
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 8000 TOWERS CRESCENT DR FL 13
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City | VIENNA
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State | VA
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Zip | 22182-6211
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Country | US
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Telephone | 866-864-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 6913 WESTLAWN DR
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City | FALLS CHURCH
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State | VA
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Zip | 22042-2651
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Country | US
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Telephone | 571-296-9919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-314590
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License Number State | VA
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