Healthcare Provider Details

I. General information

NPI: 1669026373
Provider Name (Legal Business Name): THERESA J MOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LIGHT ST APT 1
BALTIMORE MD
21230-4572
US

IV. Provider business mailing address

1450 LIGHT ST APT 1
BALTIMORE MD
21230-4572
US

V. Phone/Fax

Practice location:
  • Phone: 410-701-0547
  • Fax:
Mailing address:
  • Phone: 240-304-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC10227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: