Individual
TISHA MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
114 CHURCH ST NW STE 205, VIENNA, VA 22180-4507
(540) 999-8474
Mailing address
11218 BEAVER TRAIL CT, RESTON, VA 20191-4321
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701010496
VA
Other
Enumeration date
05/13/2021
Last updated
05/13/2021
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