Provider Demographics
NPI:1033962923
Name:BINGHAM, MOLLY L (LMHC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:L
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:L
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOLLY KINARD
Mailing Address - Street 1:5605 LARK MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5835
Mailing Address - Country:US
Mailing Address - Phone:850-766-0946
Mailing Address - Fax:
Practice Address - Street 1:5605 LARK MEADOW PL
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-5835
Practice Address - Country:US
Practice Address - Phone:850-766-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty