Provider Demographics
NPI:1417443870
Name:MOLBORN, JANEEN
Entity Type:Individual
Prefix:
First Name:JANEEN
Middle Name:
Last Name:MOLBORN
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 1:386 PENNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5756
Mailing Address - Country:US
Mailing Address - Phone:678-637-0965
Mailing Address - Fax:
Practice Address - Street 1:2605 BEN HILL RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-1900
Practice Address - Country:US
Practice Address - Phone:845-605-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional