Healthcare Provider Details

I. General information

NPI: 1972816213
Provider Name (Legal Business Name): AMY MOSES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 1/2 14TH ST
WHEELING WV
26003-3407
US

IV. Provider business mailing address

100 1/2 14TH ST
WHEELING WV
26003-3407
US

V. Phone/Fax

Practice location:
  • Phone: 304-830-7546
  • Fax: 304-404-4289
Mailing address:
  • Phone: 304-830-7546
  • Fax: 304-404-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberDP00943214
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: