Provider Demographics
NPI:1235789728
Name:MOSS, ASHLEY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6109 KENSINGTON TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3244
Mailing Address - Country:US
Mailing Address - Phone:706-570-9548
Mailing Address - Fax:
Practice Address - Street 1:100 KENSINGTON CIR
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-6992
Practice Address - Country:US
Practice Address - Phone:678-590-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012186101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor