Healthcare Provider Details

I. General information

NPI: 1780343244
Provider Name (Legal Business Name): LAI T MOY MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SPRUCE ST
PHILADELPHIA PA
19107-5601
US

IV. Provider business mailing address

133 S 18TH ST APT 3F
PHILADELPHIA PA
19103-5238
US

V. Phone/Fax

Practice location:
  • Phone: 215-259-8491
  • Fax:
Mailing address:
  • Phone: 201-725-7947
  • 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: