Provider Demographics
NPI:1174764179
Name:MOSS, CECILIA M (LMSW)
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:M
Last Name:MOSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E PARIS AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6191
Mailing Address - Country:US
Mailing Address - Phone:616-451-3888
Mailing Address - Fax:616-451-2777
Practice Address - Street 1:2525 E PARIS AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6191
Practice Address - Country:US
Practice Address - Phone:616-451-3888
Practice Address - Fax:616-451-2777
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL9039351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical