Provider Demographics
NPI:1619229762
Name:PITMAN, MOLLY HENDERY (LCSWA)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:HENDERY
Last Name:PITMAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-2702
Mailing Address - Country:US
Mailing Address - Phone:704-975-0616
Mailing Address - Fax:
Practice Address - Street 1:96 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-2702
Practice Address - Country:US
Practice Address - Phone:704-975-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0083251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP008325OtherLICENSE