Provider Demographics
NPI:1164228938
Name:MOSS, ANNISA RAASHIDA (LCMHCA)
Entity type:Individual
Prefix:
First Name:ANNISA
Middle Name:RAASHIDA
Last Name:MOSS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 NORTHBURY LN APT 937
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8675
Mailing Address - Country:US
Mailing Address - Phone:757-805-1571
Mailing Address - Fax:
Practice Address - Street 1:6915 NORTHBURY LN APT 937
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8675
Practice Address - Country:US
Practice Address - Phone:757-805-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health