Provider Demographics
NPI:1235977943
Name:MOSELEY, LARISSA CONNER (MS, BCBA)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:CONNER
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:ELISE
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-0749
Mailing Address - Country:US
Mailing Address - Phone:704-869-2088
Mailing Address - Fax:
Practice Address - Street 1:150 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-270-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst