Healthcare Provider Details

I. General information

NPI: 1003510090
Provider Name (Legal Business Name): DENNIS WADE MOSLEY BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENTON DR STE 200
CHARLESTON WV
25311-1256
US

IV. Provider business mailing address

1525 KANAWHA TER
SAINT ALBANS WV
25177-3703
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3495
  • Fax:
Mailing address:
  • Phone: 304-395-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number930
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: