Provider Demographics
NPI:1215430277
Name:MOSLEY, JADE D
Entity type:Individual
Prefix:MISS
First Name:JADE
Middle Name:D
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 GILBRALTER CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5311
Mailing Address - Country:US
Mailing Address - Phone:301-325-9212
Mailing Address - Fax:
Practice Address - Street 1:6310 GILBRALTER CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5311
Practice Address - Country:US
Practice Address - Phone:301-325-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician