=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215602917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRIA MOSLEY LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2021
-----------------------------------------------------
Last Update Date | 08/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 HOSPITAL RD
-----------------------------------------------------
City | TUSKEGEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36083-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-590-9776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 S FOX RUN PKWY APT 311
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-505-0892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 3363G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------