Healthcare Provider Details

I. General information

NPI: 1922407956
Provider Name (Legal Business Name): RAELYN MARIE MOSHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 RESILIENCE WAY
GOLDSBORO NC
27534-8067
US

IV. Provider business mailing address

3002 RESILIENCE WAY
GOLDSBORO NC
27534-8067
US

V. Phone/Fax

Practice location:
  • Phone: 919-750-8601
  • Fax: 919-551-7453
Mailing address:
  • Phone: 919-750-8601
  • Fax: 919-551-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16027
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: