Healthcare Provider Details

I. General information

NPI: 1184588816
Provider Name (Legal Business Name): TAMARA MOSER RUSH LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CONCORD PKWY S STE 100
CONCORD NC
28027-2705
US

IV. Provider business mailing address

3024 DEWITT CT NW
CONCORD NC
28027-8501
US

V. Phone/Fax

Practice location:
  • Phone: 980-209-6328
  • Fax: 704-787-8085
Mailing address:
  • Phone: 980-209-6328
  • Fax: 704-787-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRUSH-ZH059G
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: