Individual
KENISHA NICOLE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8221 WILLOW OAKS CORPORATE DR, FAIRFAX, VA 22031-4512
(703) 599-3000
Mailing address
5967 PARSONS LN, KING GEORGE, VA 22485-2434
(540) 413-6247
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0
—
Other
Enumeration date
10/06/2020
Last updated
01/25/2024
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