Healthcare Provider Details

I. General information

NPI: 1154242170
Provider Name (Legal Business Name): MAKAYLA JOY MOSER-PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 SAM NEWELL RD STE A
MATTHEWS NC
28105-5084
US

IV. Provider business mailing address

1733 MUSCLEWOOD CT
CLOVER SC
29710-8871
US

V. Phone/Fax

Practice location:
  • Phone: 704-593-6920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: