Provider Demographics
NPI:1114369824
Name:MOSCONA, GEORGE C (LPCC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:C
Last Name:MOSCONA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:RIO COMMUNITIES
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7230
Mailing Address - Country:US
Mailing Address - Phone:505-453-4169
Mailing Address - Fax:
Practice Address - Street 1:702 WESTERN DR
Practice Address - Street 2:
Practice Address - City:RIO COMMUNITIES
Practice Address - State:NM
Practice Address - Zip Code:87002-7230
Practice Address - Country:US
Practice Address - Phone:505-453-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0136691101Y00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor