Healthcare Provider Details

I. General information

NPI: 1144701996
Provider Name (Legal Business Name): MOXIE PROFESSIONAL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 STATE ST STE B
NEWBURGH IN
47630-1270
US

IV. Provider business mailing address

PO BOX 784
NEWBURGH IN
47629-0784
US

V. Phone/Fax

Practice location:
  • Phone: 812-777-5230
  • Fax: 812-315-0222
Mailing address:
  • Phone: 812-777-5230
  • Fax: 812-315-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE DEVONSHIRE
Title or Position: OWNER
Credential: LCSW
Phone: 812-499-5004