Provider Demographics
NPI:1205509122
Name:MOSS, RACHEL JEAN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JEAN
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 TOLLESON AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3441
Mailing Address - Country:US
Mailing Address - Phone:478-988-9295
Mailing Address - Fax:
Practice Address - Street 1:1335 N 5TH STREET EXT STE B
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3753
Practice Address - Country:US
Practice Address - Phone:229-273-2091
Practice Address - Fax:229-273-2022
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health