Provider Demographics
NPI:1891534202
Name:MOSLEY, SCARLETT ASHLEIGH PRINCE (MS)
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:ASHLEIGH PRINCE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-0745
Mailing Address - Country:US
Mailing Address - Phone:706-266-1140
Mailing Address - Fax:
Practice Address - Street 1:105 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1535
Practice Address - Country:US
Practice Address - Phone:706-457-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101Y00000X
GAAPC009861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor