Provider Demographics
NPI:1871078543
Name:MOSS, CHARLOTTE ANN (LCAS)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:MOSS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11814 US 64 A
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882
Mailing Address - Country:US
Mailing Address - Phone:252-903-5594
Mailing Address - Fax:
Practice Address - Street 1:11814 US 64 A
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882
Practice Address - Country:US
Practice Address - Phone:252-903-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24497101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)