Healthcare Provider Details

I. General information

NPI: 1649501784
Provider Name (Legal Business Name): CHARMANIKA KESONA MOSLEY SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHARMANIKA KESONA WILLIAMS

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8690 BROADWAY STE A
MERRILLVILLE IN
46410-7034
US

IV. Provider business mailing address

2059 GOVERT DR
SCHERERVILLE IN
46375-5126
US

V. Phone/Fax

Practice location:
  • Phone: 219-750-9600
  • Fax:
Mailing address:
  • Phone: 708-679-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005423A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10114940
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: