Provider Demographics
NPI:1609202241
Name:MOSS, ZONDRA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ZONDRA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ZONDRA
Other - Middle Name:
Other - Last Name:JOHNSON-MOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFTA
Mailing Address - Street 1:624 BELMORROW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1110
Mailing Address - Country:US
Mailing Address - Phone:828-243-6171
Mailing Address - Fax:
Practice Address - Street 1:4614 WILGROVE MINT HILL RD STE C13
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3547
Practice Address - Country:US
Practice Address - Phone:980-365-0207
Practice Address - Fax:704-907-3531
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1695101Y00000X, 251S00000X, 106H00000X
NC7091A101Y00000X, 106H00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health