Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810001815 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810001815 | VA |
NPI | 1003970179 |
---|---|
Provider Name | Dr. Susan Dohr Moss |
First Address | Charlottesville, VA 22902 |
Second Address | Charlottesville, VA 22902-5311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 26/12/2008 |