Provider Demographics
NPI:1407260383
Name:LEVINE-HUNT, MOLLY BLAIR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:BLAIR
Last Name:LEVINE-HUNT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:BLAIR
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4549 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6210
Mailing Address - Country:US
Mailing Address - Phone:678-557-6212
Mailing Address - Fax:770-677-9400
Practice Address - Street 1:4549 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6210
Practice Address - Country:US
Practice Address - Phone:678-557-6212
Practice Address - Fax:770-677-9400
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58-1479212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health