Provider Demographics
NPI:1710010855
Name:MOSES, JENNIFER KAISER (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAISER
Last Name:MOSES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 RED FOX CT
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2368
Mailing Address - Country:US
Mailing Address - Phone:252-447-2575
Mailing Address - Fax:
Practice Address - Street 1:2117 S GLENBURNIE RD
Practice Address - Street 2:SUITE 17, 18
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2239
Practice Address - Country:US
Practice Address - Phone:252-633-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional