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General NPI Number Information
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NPI Number | 1770758864
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Entity Type | Organization
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Legal Business Name | FRED T. MOELLER AND ASSOCIATES
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 11805 NORTHFALL LANE SUITE 804
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City | ALPHARETTA
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State | GA
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Zip | 30009
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Country | US
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Telephone | 770-410-5788
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Fax | 770-410-4041
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Provider Business Mailing Address
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Address Line | 11805 NORTHFALL LANE SUITE 804
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City | ALPHARETTA
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State | GA
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Zip | 30009
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Country | US
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Telephone | 770-410-5788
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Fax | 770-410-4041
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FRED T MOELLER
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Credential | M.H.R.
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Telephone | 770-410-5788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2084
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License Number State | GA
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