Provider Demographics
NPI:1609633189
Name:DUGAN, MOLLY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:DUGAN
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 1:117 NORTHERN AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2407
Mailing Address - Country:US
Mailing Address - Phone:404-285-5350
Mailing Address - Fax:
Practice Address - Street 1:117 NORTHERN AVE APT 7
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2407
Practice Address - Country:US
Practice Address - Phone:404-285-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0029851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical