Healthcare Provider Details

I. General information

NPI: 1003376914
Provider Name (Legal Business Name): RAQUAN DANT'E MOSER LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 PARK RD STE 208
CHARLOTTE NC
28210-0106
US

IV. Provider business mailing address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020347
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: