Healthcare Provider Details

I. General information

NPI: 1568292233
Provider Name (Legal Business Name): MOXIE MENTAL HEALTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 5TH AVE STE A267
NEW YORK NY
10001-7604
US

IV. Provider business mailing address

2047 ELIZABETH AVE
WINSTON SALEM NC
27103-2603
US

V. Phone/Fax

Practice location:
  • Phone: 347-395-6180
  • Fax:
Mailing address:
  • Phone: 346-395-6180
  • 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: ALEXANDRA MIRANDA
Title or Position: MEMBER-MANAGER
Credential:
Phone: 347-395-6180