Provider Demographics
NPI:1780913319
Name:MOSER, ROBERT WADE (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WADE
Last Name:MOSER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 WRIGHTSVILLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4140
Mailing Address - Country:US
Mailing Address - Phone:704-251-7789
Mailing Address - Fax:
Practice Address - Street 1:3725 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4140
Practice Address - Country:US
Practice Address - Phone:704-251-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7434101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health