Provider Demographics
NPI:1598278442
Name:MOSHIRI, FARAH (LPCA)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:MOSHIRI
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5312
Mailing Address - Country:US
Mailing Address - Phone:910-860-7008
Mailing Address - Fax:910-221-9006
Practice Address - Street 1:131 W EDINBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2861
Practice Address - Country:US
Practice Address - Phone:910-848-1222
Practice Address - Fax:910-848-0222
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health