Provider Demographics
NPI:1902345390
Name:MOSS-SAVAGE, CHEVELLE (LPC)
Entity type:Individual
Prefix:
First Name:CHEVELLE
Middle Name:
Last Name:MOSS-SAVAGE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 422A
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6159
Mailing Address - Country:US
Mailing Address - Phone:804-621-2603
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST STE 422A
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6159
Practice Address - Country:US
Practice Address - Phone:804-621-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003438101YP2500X
VA0701006991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional