Provider Demographics
NPI:1972047199
Name:DEYTON, MOLLY ELIZABETH DWYER (LICSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH DWYER
Last Name:DEYTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:2209 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401
Mailing Address - Country:US
Mailing Address - Phone:205-391-3131
Mailing Address - Fax:205-391-3137
Practice Address - Street 1:2209 9TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2300
Practice Address - Country:US
Practice Address - Phone:205-391-3131
Practice Address - Fax:205-391-3137
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3808C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical