Provider Demographics
NPI:1174771737
Name:MOORE, MELINDA BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:BETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15521 MIDLOTHIAN TURNPIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114
Mailing Address - Country:US
Mailing Address - Phone:804-730-2829
Mailing Address - Fax:804-730-2829
Practice Address - Street 1:15521 MIDLOTHIAN TURNPIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-730-2829
Practice Address - Fax:804-730-2829
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical