Provider Demographics
NPI:1750646931
Name:MOSS COUNSELING SERVICES PLLC.
Entity type:Organization
Organization Name:MOSS COUNSELING SERVICES PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA/LPC
Authorized Official - Phone:704-493-8535
Mailing Address - Street 1:7434 BEAUFORT CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1216
Mailing Address - Country:US
Mailing Address - Phone:704-493-8535
Mailing Address - Fax:704-567-9522
Practice Address - Street 1:4917 ALBEMARLE RD STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6454
Practice Address - Country:US
Practice Address - Phone:704-567-9522
Practice Address - Fax:704-567-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty