Provider Demographics
NPI:1851958136
Name:MOXLEY, KRYSTLE ANN (LCMHC)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:ANN
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 WEATHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2627
Mailing Address - Country:US
Mailing Address - Phone:910-912-4673
Mailing Address - Fax:
Practice Address - Street 1:5605 WEATHERFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2627
Practice Address - Country:US
Practice Address - Phone:910-912-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6698101YM0800X
NCA16787101YM0800X
171M00000X
NC16787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator