Provider Demographics
NPI:1518165257
Name:MOLL, JAMES MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MOLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12661 NANELL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1517
Mailing Address - Country:US
Mailing Address - Phone:314-303-6559
Mailing Address - Fax:
Practice Address - Street 1:4144 LINDELL BLVD
Practice Address - Street 2:SUITE #401
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2927
Practice Address - Country:US
Practice Address - Phone:314-303-6559
Practice Address - Fax:314-842-1822
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060117171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical