Healthcare Provider Details

I. General information

NPI: 1194273441
Provider Name (Legal Business Name): SHEQUITA MOXEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CARPENTER DR STE 400
ATLANTA GA
30328-4933
US

IV. Provider business mailing address

3204 WANSTEAD PARK DR APT 304
SUWANEE GA
30024-0070
US

V. Phone/Fax

Practice location:
  • Phone: 678-460-0345
  • Fax:
Mailing address:
  • Phone: 678-510-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013601
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: