Individual
CHANNING ALTON MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
6330 NEWTOWN RD STE 625, NORFOLK, VA 23502-4808
(757) 206-2378
Mailing address
912 SPOTSWOOD AVE APT B3, NORFOLK, VA 23517-1736
(804) 238-7421
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
VA
101YM0800X
Mental Health Counselor
Primary
0704015307
VA
101YP2500X
Professional Counselor
—
VA
Other
Enumeration date
09/26/2022
Last updated
10/10/2022
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