MEDICARE: MOSS COUNSELING SERVICES PLLC.

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	8037	NC

General Provider Information

NPI Number	:	1750646931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSS COUNSELING SERVICES PLLC.

Provider Business Mailing Address
First Line	:	7434 BEAUFORT CIR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-1216
Country	:	US
Telephone Number	:	704-493-8535
Fax Number	:	704-567-9522

Provider Business Practice Location Address
First Line	:	4917 ALBEMARLE RD STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6454
Country	:	US
Telephone Number	:	704-567-9522
Fax Number	:	704-567-9522

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. BEVERLY LOUISE MOSS
Credential	:	MA/LPC
Telephone Number	:	704-493-8535

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	05/13/2019

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