Provider Demographics
NPI:1699820001
Name:CHIN, MOLLY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ANN
Last Name:CHIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:JACKSON-IVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 AKERS FARM RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4866
Mailing Address - Country:US
Mailing Address - Phone:540-381-6215
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:125 AKERS FARM RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4866
Practice Address - Country:US
Practice Address - Phone:540-381-6215
Practice Address - Fax:870-972-4911
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical