| NPI | 1821515198 |
|---|---|
| Former Name | MICTISSA MOSELEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-08-27 |
| Last Update Date | 2020-03-19 |