Provider Demographics
NPI:1972913648
Name:MOLLNOW, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:MOLLNOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 EVANS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9653
Mailing Address - Country:US
Mailing Address - Phone:919-629-6100
Mailing Address - Fax:
Practice Address - Street 1:1616 EVANS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9653
Practice Address - Country:US
Practice Address - Phone:919-629-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3196103TC0700X
NC4828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical