Healthcare Provider Details

I. General information

NPI: 1457443616
Provider Name (Legal Business Name): PATRICIA W. MOSDEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 BANKS STONE DR
RALEIGH NC
27603-4856
US

IV. Provider business mailing address

4016 BANKS STONE DR
RALEIGH NC
27603-4856
US

V. Phone/Fax

Practice location:
  • Phone: 919-772-7300
  • Fax: 919-772-7300
Mailing address:
  • Phone: 919-772-7300
  • Fax: 919-772-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC000396
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000396
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: