Provider Demographics
NPI:1568592624
Name:MOLLIC, JUNE MARIE (MS ED LPCC LSW)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:MARIE
Last Name:MOLLIC
Suffix:
Gender:F
Credentials:MS ED LPCC LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 THOMAS LANE
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420
Mailing Address - Country:US
Mailing Address - Phone:330-399-6451
Mailing Address - Fax:330-394-6266
Practice Address - Street 1:150 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481
Practice Address - Country:US
Practice Address - Phone:330-399-6451
Practice Address - Fax:330-394-6266
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001913101YM0800X
S0010150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
200345649001OtherMEDICAL MUTUAL
OH000000125414OtherANTHEM