Individual
MISS ALICIA MARCELLA MOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
1251 KEMPSVILLE RD, NORFOLK, VA 23502-2643
(757) 524-1593
Mailing address
925 BRANDON AVE APT C4, NORFOLK, VA 23517-1655
(703) 851-6829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601424504
—
VA
Enumeration date
09/01/2021
Last updated
09/01/2021
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