Provider Demographics
NPI:1891266821
Name:MOSS, ERIC A (CADAC II, MATS)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:MOSS
Suffix:
Gender:M
Credentials:CADAC II, MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 N MERIDIAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1358
Mailing Address - Country:US
Mailing Address - Phone:317-926-5463
Mailing Address - Fax:317-926-5498
Practice Address - Street 1:2105 N MERIDIAN ST STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1358
Practice Address - Country:US
Practice Address - Phone:317-926-5463
Practice Address - Fax:317-926-5498
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)