Provider Demographics
NPI:1801101357
Name:MOSS, BEVERLY LOUISE (LPC)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:LOUISE
Last Name:MOSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7434 BEAUFORT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227
Mailing Address - Country:US
Mailing Address - Phone:704-567-9522
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:704-567-7733
Practice Address - Fax:704-567-9522
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8037101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health