Healthcare Provider Details

I. General information

NPI: 1073981213
Provider Name (Legal Business Name): ALYSSA MOSS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA DALE LPC

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 WARWICK BLVD
NEWPORT NEWS VA
23607-1514
US

IV. Provider business mailing address

116 PARK AVE
NEWPORT NEWS VA
23607-5522
US

V. Phone/Fax

Practice location:
  • Phone: 757-522-7079
  • Fax:
Mailing address:
  • Phone: 757-876-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006312
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701006312
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: