Healthcare Provider Details

I. General information

NPI: 1386915742
Provider Name (Legal Business Name): ASHLEY ELIZABETH MOSER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY SHEIL LMFT

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

IV. Provider business mailing address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-1264
  • Fax: 704-442-4162
Mailing address:
  • Phone: 704-366-1264
  • Fax: 704-442-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1571
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000854
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: