Provider Demographics
NPI:1619014099
Name:MOSS, PATRICIA B (APRN,CS,BC, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:B
Last Name:MOSS
Suffix:
Gender:F
Credentials:APRN,CS,BC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 CHAUCER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6588
Mailing Address - Country:US
Mailing Address - Phone:706-373-7900
Mailing Address - Fax:877-748-6950
Practice Address - Street 1:2618 CHAUCER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6588
Practice Address - Country:US
Practice Address - Phone:706-373-7900
Practice Address - Fax:877-748-6950
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN043959163WP0809X
GALPC002573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006429956AMedicaid
GA006429956AMedicaid
GA006429956AMedicaid