Provider Demographics
NPI:1871980011
Name:MOSS, LOIS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 SAINT PAULS CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1092
Mailing Address - Country:US
Mailing Address - Phone:770-861-0253
Mailing Address - Fax:404-494-7701
Practice Address - Street 1:1 W COURT SQ
Practice Address - Street 2:SUITE 750
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2538
Practice Address - Country:US
Practice Address - Phone:770-861-0253
Practice Address - Fax:404-494-7701
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148017BMedicaid
GA003152532AMedicaid