Provider Demographics
NPI:1922407956
Name:MOSHER, RAELYN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RAELYN
Middle Name:MARIE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501
Mailing Address - Country:US
Mailing Address - Phone:252-522-7508
Mailing Address - Fax:252-522-7082
Practice Address - Street 1:100 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501
Practice Address - Country:US
Practice Address - Phone:252-522-7508
Practice Address - Fax:252-522-7082
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW160271041C0700X
NCC0120811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical