Provider Demographics
NPI:1104632454
Name:MORA, CAROLINA ANDREA
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ANDREA
Last Name:MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 WESTLAWN DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2651
Mailing Address - Country:US
Mailing Address - Phone:571-296-9919
Mailing Address - Fax:
Practice Address - Street 1:8000 TOWERS CRESCENT DR FL 13
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-6211
Practice Address - Country:US
Practice Address - Phone:866-864-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-314590106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician