Provider Demographics
NPI:1205375540
Name:YUSSIF, MOUTIA (LPC-A)
Entity Type:Individual
Prefix:
First Name:MOUTIA
Middle Name:
Last Name:YUSSIF
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6622
Mailing Address - Country:US
Mailing Address - Phone:336-370-9232
Mailing Address - Fax:336-274-7200
Practice Address - Street 1:1207 4TH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6622
Practice Address - Country:US
Practice Address - Phone:336-370-9232
Practice Address - Fax:336-274-7200
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health