Provider Demographics
NPI:1790955383
Name:MOSES, GLORIA GENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:GENE
Last Name:MOSES
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 1:114 E HALL ST
Mailing Address - Street 2:P. O. BOX 10
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-2726
Mailing Address - Country:US
Mailing Address - Phone:706-595-2548
Mailing Address - Fax:706-595-3070
Practice Address - Street 1:114 E HALL ST
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2726
Practice Address - Country:US
Practice Address - Phone:706-595-2548
Practice Address - Fax:706-595-3070
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health