Provider Demographics
NPI:1790260727
Name:GIANNOTTA, MOLLY (MS, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GIANNOTTA
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 US 1 S STE 603
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7282
Mailing Address - Country:US
Mailing Address - Phone:904-429-6619
Mailing Address - Fax:
Practice Address - Street 1:4475 US 1 S STE 603
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7282
Practice Address - Country:US
Practice Address - Phone:904-429-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty