Provider Demographics
NPI:1427804202
Name:MOREAU, SHELBY DAWN (RBT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:DAWN
Last Name:MOREAU
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:DAWN
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:8230 LEESBURG PIKE STE 740
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2641
Mailing Address - Country:US
Mailing Address - Phone:877-504-4141
Mailing Address - Fax:
Practice Address - Street 1:8230 LEESBURG PIKE STE 740
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2641
Practice Address - Country:US
Practice Address - Phone:877-504-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician