Doctor Name: | MS. PAMELA MOODY |
NPI Number: | 1003224304 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LCP5663 |
Business Practice Address: | 9314 Piscataway Rd Room 152 Clinton, MD - 207353630 |
Business Phone Number: | 3018569512 |
Business Fax Number: | 3018569589 |
Mailing Address: | 9314 Piscataway Rd, Room 152 CLINTON |
State: | MD |
Postal Code: | 207353630 |
Phone Number: | 3018569512 |
Fax Number: | 3018569589 |
NPI Enumeration Date: | 07/30/2014 |
NPI Last Update Date: | 07/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LCP5663 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |