Individual
GRACE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8221 WILLOW OAKS CORPORATE DR, FAIRFAX, VA 22031-4512
(703) 559-3000
Mailing address
8221 WILLOW OAKS CORPORATE DR, FAIRFAX, VA 22031-4512
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
0904016165
VA
1041C0700X
Clinical Social Worker
LC200002782
DC
Other
Enumeration date
05/01/2017
Last updated
06/25/2024
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