Provider Demographics
NPI:1407868185
Name:GALLACHER, MOLLY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:LYNN
Last Name:GALLACHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27207 FUDGE RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9447
Mailing Address - Country:US
Mailing Address - Phone:276-695-0245
Mailing Address - Fax:804-412-2985
Practice Address - Street 1:27207 FUDGE RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9447
Practice Address - Country:US
Practice Address - Phone:276-695-0245
Practice Address - Fax:804-412-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005571101YM0800X
TN4450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010217831Medicaid
VAC09825Medicare ID - Type Unspecified