Provider Demographics
NPI:1992976682
Name:MOSES, HOLLY BLANC (MS)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BLANC
Last Name:MOSES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3643
Mailing Address - Country:US
Mailing Address - Phone:919-813-9415
Mailing Address - Fax:
Practice Address - Street 1:140 WIND CHIME CT STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6580
Practice Address - Country:US
Practice Address - Phone:919-946-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional