Healthcare Provider Details

I. General information

NPI: 1679540876
Provider Name (Legal Business Name): GEORGE D MOSES ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 MAPLE DR SUITE 1
MORGANTOWN WV
26505-2815
US

IV. Provider business mailing address

20 ALEXANDER DR
MORGANTOWN WV
26508-9448
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-5751
  • Fax: 304-599-2124
Mailing address:
  • Phone: 304-599-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number558
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: