Provider Demographics
NPI:1225664600
Name:MOSES, SHELLY-ANN MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:SHELLY-ANN
Middle Name:MICHELLE
Last Name:MOSES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 HIGHWAY 20 SE STE 114
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2076
Mailing Address - Country:US
Mailing Address - Phone:770-648-3433
Mailing Address - Fax:
Practice Address - Street 1:1820 HIGHWAY 20 SE STE 114
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2076
Practice Address - Country:US
Practice Address - Phone:770-648-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GALPC015347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1144528787Medicaid