Provider Demographics
NPI:1992388011
Name:MOSLEY, KRISTIN (LCMHC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 MESHACK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-0236
Mailing Address - Country:US
Mailing Address - Phone:704-561-1286
Mailing Address - Fax:
Practice Address - Street 1:5641 POPLAR TENT RD STE 204
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7588
Practice Address - Country:US
Practice Address - Phone:704-561-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13056101YM0800X
NCA13056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC758308OtherLICENSE