Provider Demographics
NPI:1194140616
Name:MOSLEY, THERESA (EDD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 HARPERS WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5176
Mailing Address - Country:US
Mailing Address - Phone:601-527-3533
Mailing Address - Fax:
Practice Address - Street 1:2392 HARPERS WAY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5176
Practice Address - Country:US
Practice Address - Phone:601-527-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist