Provider Demographics
NPI:1659026375
Name:MCGOWAN, MOLLY DIANE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DIANE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 2ND AVE N APT 206
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3131
Mailing Address - Country:US
Mailing Address - Phone:706-594-6875
Mailing Address - Fax:
Practice Address - Street 1:151 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-4445
Practice Address - Country:US
Practice Address - Phone:205-941-1799
Practice Address - Fax:205-942-2037
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4471OtherALABAMA BOARD OF EXAMINERS IN COUNSELING