Provider Demographics
NPI:1417924747
Name:KIEFER, MOLLY VAN COUTREN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:VAN COUTREN
Last Name:KIEFER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 NATIONAL DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4067
Mailing Address - Country:US
Mailing Address - Phone:919-881-4198
Mailing Address - Fax:
Practice Address - Street 1:3717 NATIONAL DR
Practice Address - Street 2:SUITE 119
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4067
Practice Address - Country:US
Practice Address - Phone:919-881-4198
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical