Provider Demographics
NPI:1891157962
Name:MOSELEY, BRANDON (LCPC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 ORINDA CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-1651
Mailing Address - Country:US
Mailing Address - Phone:410-736-2608
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:410-337-5523
Practice Address - Fax:410-736-2508
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6713101YM0800X
MDLC7996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health