Healthcare Provider Details

I. General information

NPI: 1851958136
Provider Name (Legal Business Name): KRYSTLE ANN MOXLEY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 WEATHERFORD RD
FAYETTEVILLE NC
28303-2627
US

IV. Provider business mailing address

5605 WEATHERFORD RD
FAYETTEVILLE NC
28303-2627
US

V. Phone/Fax

Practice location:
  • Phone: 910-912-4673
  • Fax:
Mailing address:
  • Phone: 910-912-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR6698
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA16787
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: