Individual
KEVIN MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3771 HUMMINGBIRD LN, ROANOKE, VA 24018-5111
(540) 526-5919
Mailing address
3771 HUMMINGBIRD LN, ROANOKE, VA 24018-5111
(540) 526-5919
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-201684
VA
Other
Enumeration date
04/03/2022
Last updated
04/03/2022
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