Healthcare Provider Details

I. General information

NPI: 1588572671
Provider Name (Legal Business Name): LATOYA S MOSS NCC, LPC, CPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GARDEN WALK
STOCKBRIDGE GA
30281-7334
US

IV. Provider business mailing address

115 GARDEN WALK
STOCKBRIDGE GA
30281-7334
US

V. Phone/Fax

Practice location:
  • Phone: 678-310-9154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008108
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: