Provider Demographics
NPI:1477265205
Name:MOSS, MICHELLE LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:MOSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 861345
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35486-0012
Mailing Address - Country:US
Mailing Address - Phone:205-765-1080
Mailing Address - Fax:
Practice Address - Street 1:2804 8TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2108
Practice Address - Country:US
Practice Address - Phone:205-765-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5503C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker