Individual
JEANNINE LYNNE MOGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1736 S PARK CT STE 201, CHESAPEAKE, VA 23320-8922
(757) 296-0800
Mailing address
107 ST ANDREWS, SMITHFIELD, VA 23430-7169
(616) 745-6148
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
007932
NC
1041C0700X
Clinical Social Worker
Primary
0904010501
VA
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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