Provider Demographics
NPI:1215576764
Name:DOUGLASS, MOLLY A (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:HELLMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:415 N 26TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 N 26TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2856
Practice Address - Country:US
Practice Address - Phone:765-583-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008750A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical