Provider Demographics
NPI:1093144404
Name:MOSS, MARIA (CACIII, NCACII)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:CACIII, NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2927
Mailing Address - Country:US
Mailing Address - Phone:720-338-1810
Mailing Address - Fax:
Practice Address - Street 1:121 ACOMA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1429
Practice Address - Country:US
Practice Address - Phone:303-800-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC 0020808101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)