Provider Demographics
NPI:1063988434
Name:MOSES, ALEXANDRA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JEAN
Last Name:MOSES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FAHM ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2391
Mailing Address - Country:US
Mailing Address - Phone:240-370-4515
Mailing Address - Fax:
Practice Address - Street 1:107 FAHM ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2391
Practice Address - Country:US
Practice Address - Phone:912-238-2777
Practice Address - Fax:912-238-2773
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional