Provider Demographics
NPI:1013674936
Name:MATTESON, MOLLIE (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:
Last Name:MATTESON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:
Other - Last Name:MATTESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-0551
Mailing Address - Country:US
Mailing Address - Phone:802-448-0618
Mailing Address - Fax:
Practice Address - Street 1:37 HAPGOOD LANE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-0551
Practice Address - Country:US
Practice Address - Phone:802-448-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health