Individual
PAT MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2333 DULLES STATION BLVD APT I-201, HERNDON, VA 20171-6398
(626) 660-5383
Mailing address
2333 DULLES STATION BLVD APT I-201, HERNDON, VA 20171-6398
(626) 660-5383
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810005192
VA
Other
Enumeration date
05/06/2015
Last updated
05/06/2015
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