Individual
MRS. STEPHANIE A MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
274236485
FEDERAL I D
VA
Enumeration date
04/19/2013
Last updated
04/19/2013
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