Provider Demographics
NPI:1114197951
Name:DOLL, MOLLY BROWN (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BROWN
Last Name:DOLL
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 SE ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5759
Mailing Address - Country:US
Mailing Address - Phone:503-504-6455
Mailing Address - Fax:844-792-9639
Practice Address - Street 1:2928 SE HAWTHORNE BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4147
Practice Address - Country:US
Practice Address - Phone:503-504-6455
Practice Address - Fax:844-792-9639
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC3108101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500660733Medicaid
OR210855Medicaid