Provider Demographics
NPI:1164908166
Name:GRANT, MOLLY (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ORVILLE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2941
Mailing Address - Country:US
Mailing Address - Phone:508-562-0491
Mailing Address - Fax:
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2372
Practice Address - Country:US
Practice Address - Phone:937-434-0540
Practice Address - Fax:937-434-6726
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO121331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical