Provider Demographics
NPI:1538200910
Name:MOSS, BONITA JANE (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:JANE
Last Name:MOSS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 MAPLE AVE..
Mailing Address - Street 2:UNIT A
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6108
Mailing Address - Country:US
Mailing Address - Phone:336-229-9457
Mailing Address - Fax:
Practice Address - Street 1:2260 S CHURCH ST
Practice Address - Street 2:SUITE 506
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5390
Practice Address - Country:US
Practice Address - Phone:336-223-0444
Practice Address - Fax:336-223-0449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0005751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical