Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1003212358 |
---|---|
Provider Name | Reggie Moses |
First Address | Charlotte, NC 28203-5204 |
Second Address | Charlotte, NC 28203-5204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 14/11/2014 |