Provider Demographics
NPI:1831305705
Name:MOLL, ERNESTINE CHRISTINE (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ERNESTINE
Middle Name:CHRISTINE
Last Name:MOLL
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:DR
Other - First Name:E. CHRISTINE
Other - Middle Name:
Other - Last Name:MOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:75 WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2717
Mailing Address - Country:US
Mailing Address - Phone:716-834-1318
Mailing Address - Fax:
Practice Address - Street 1:35 CENTRAL AVE # A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2143
Practice Address - Country:US
Practice Address - Phone:716-839-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-002640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health