Provider Demographics
NPI:1609021427
Name:MOSER, NANCY XENIA (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:XENIA
Last Name:MOSER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 SUN VALLEY DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5615
Mailing Address - Country:US
Mailing Address - Phone:770-653-5705
Mailing Address - Fax:770-642-4239
Practice Address - Street 1:490 SUN VALLEY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5615
Practice Address - Country:US
Practice Address - Phone:770-653-5705
Practice Address - Fax:770-642-4239
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional