Provider Demographics
NPI:1679540876
Name:MOSES, GEORGE D (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:MOSES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9448
Mailing Address - Country:US
Mailing Address - Phone:304-599-9582
Mailing Address - Fax:
Practice Address - Street 1:1062 MAPLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2815
Practice Address - Country:US
Practice Address - Phone:304-599-5751
Practice Address - Fax:304-599-2124
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV058667OtherVALUE OPTIONS