Healthcare Provider Details

I. General information

NPI: 1649101775
Provider Name (Legal Business Name): MS. GLADYS A MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 HATTIES PROGRESS DR
BOWIE MD
20720-6313
US

IV. Provider business mailing address

4535 HATTIES PROGRESS DR
BOWIE MD
20720-6313
US

V. Phone/Fax

Practice location:
  • Phone: 240-505-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR205484
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: