Healthcare Provider Details

I. General information

NPI: 1164820890
Provider Name (Legal Business Name): JOY MOSERI LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MOSERI RD
DECATUR GA
30032-5116
US

IV. Provider business mailing address

1810 MOSERI RD
DECATUR GA
30032-5116
US

V. Phone/Fax

Practice location:
  • Phone: 404-289-8223
  • Fax: 678-705-3735
Mailing address:
  • Phone: 404-289-8223
  • Fax: 678-705-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC0003728
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2056
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: