MEDICARE: ANNALEIGHA R MORIARTY MPS, LPC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8573	FL
2	101YP2500X	Professional Counselor	005279	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568612612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNALEIGHA R MORIARTY MPS, LPC, LMHC

Provider Business Mailing Address
First Line	:	2450 ATLANTA HWY STE 1503
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 ATLANTA HWY STE 1503
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1277
Country	:	US
Telephone Number	:	678-722-1031
Fax Number	:	470-297-3660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	05/24/2019

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