Provider Demographics
NPI:1356010490
Name:TOWERS HERRINGTON, MOLLY NICOLE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:NICOLE
Last Name:TOWERS HERRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 SW ARCHER RD APT 723
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2247
Mailing Address - Country:US
Mailing Address - Phone:352-240-2805
Mailing Address - Fax:
Practice Address - Street 1:9149 SW 49TH PL # L101
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8195
Practice Address - Country:US
Practice Address - Phone:352-554-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-180267106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician