Provider Demographics
NPI:1417515206
Name:STALLINGS, MOLLY GRACE (LW61331175)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:GRACE
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:LW61331175
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 SCAMMELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4750
Mailing Address - Country:US
Mailing Address - Phone:615-428-1395
Mailing Address - Fax:
Practice Address - Street 1:1914 SCAMMELL AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4750
Practice Address - Country:US
Practice Address - Phone:615-428-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW613311751041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical