Provider Demographics
NPI:1780490987
Name:MOSS, ALICIA LATICHA
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:LATICHA
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 MILLBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-5190
Mailing Address - Country:US
Mailing Address - Phone:252-267-4554
Mailing Address - Fax:
Practice Address - Street 1:506 MILLBROOKE CIR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5190
Practice Address - Country:US
Practice Address - Phone:252-267-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO203281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical