Provider Demographics
NPI:1790391878
Name:MOLIK, MADELAINA ELISE
Entity Type:Individual
Prefix:
First Name:MADELAINA
Middle Name:ELISE
Last Name:MOLIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADELAINA
Other - Middle Name:ELISE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 AMERICANA DR APT 46
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3153
Mailing Address - Country:US
Mailing Address - Phone:661-429-7583
Mailing Address - Fax:
Practice Address - Street 1:700 AMERICANA DR APT 46
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3153
Practice Address - Country:US
Practice Address - Phone:661-429-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician