Individual
ANDREA MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1802 S MATTIS AVE, CHAMPAIGN, IL 61821-5923
(217) 383-1850
(217) 383-3439
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149012800
IL
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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