Provider Demographics
NPI:1437597440
Name:CARL, MOLLIE KIMMELMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:KIMMELMAN
Last Name:CARL
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 1:1214 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3742
Mailing Address - Country:US
Mailing Address - Phone:214-458-1212
Mailing Address - Fax:
Practice Address - Street 1:1214 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3742
Practice Address - Country:US
Practice Address - Phone:214-458-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004929101YM0800X
VA09040117681041C0700X
CA721401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health