Provider Demographics
NPI:1073532446
Name:DEAN, MOLLY ANN (MA LPC CAADC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:F
Credentials:MA LPC CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LASALLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4153
Mailing Address - Country:US
Mailing Address - Phone:517-214-5210
Mailing Address - Fax:
Practice Address - Street 1:427 LASALLE BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4153
Practice Address - Country:US
Practice Address - Phone:517-214-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008674101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional