Provider Demographics
NPI:1689429383
Name:MOSLEY, DENISE YVETTE
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:YVETTE
Last Name:MOSLEY
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 1:1143 WEST AVE SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-5280
Mailing Address - Country:US
Mailing Address - Phone:857-829-4040
Mailing Address - Fax:
Practice Address - Street 1:1143 WEST AVE SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5280
Practice Address - Country:US
Practice Address - Phone:857-829-4040
Practice Address - Fax:844-965-9105
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician