Provider Demographics
NPI:1437399722
Name:DAUGHTRY, MOLLYE (MOLLYE DAUGHTRY)
Entity Type:Individual
Prefix:MS
First Name:MOLLYE
Middle Name:
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:MOLLYE DAUGHTRY
Other - Prefix:
Other - First Name:MOLLYE
Other - Middle Name:
Other - Last Name:DAUGHTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOLLYE DAUGHTRY
Mailing Address - Street 1:2105 VISTADALE CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5418
Mailing Address - Country:US
Mailing Address - Phone:404-372-5478
Mailing Address - Fax:404-325-2750
Practice Address - Street 1:2105 VISTADALE CT
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5418
Practice Address - Country:US
Practice Address - Phone:404-372-5478
Practice Address - Fax:404-325-2750
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional