Provider Demographics
NPI:1659968972
Name:AUSTIN, MOLLIE N
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:N
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 GUYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-1007
Mailing Address - Country:US
Mailing Address - Phone:304-731-0297
Mailing Address - Fax:
Practice Address - Street 1:955 GUYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-1007
Practice Address - Country:US
Practice Address - Phone:304-731-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator