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General NPI Number Information
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NPI Number | 1205721107
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Entity Type | Organization
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Legal Business Name | ANXIETY RESET PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1198 RIDGEFORD DR
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City | CONWAY
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State | SC
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Zip | 29526-2375
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Country | US
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Telephone | 910-377-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 POSTAL WAY UNIT 50142
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-2008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANAHVIA TAIYIB MOODY
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Credential | PHD
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Telephone | 910-377-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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