Organization
THERESA MOON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA G. MOON (SERVICE FACILITATOR)
(434) 821-2114
Entity
Organization
Contact information
Practice address
565 LYNBROOK RD, RUSTBURG, VA 24588-3574
(434) 821-2114
(434) 821-4734
Mailing address
565 LYNBROOK RD, RUSTBURG, VA 24588-3574
(434) 821-2114
(434) 821-4734
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157008159
—
VA
Enumeration date
08/16/2010
Last updated
08/16/2010
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