Provider Demographics
NPI:1013801356
Name:PETERSON, MOLLY MOSELEY (NBC-HWC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MOSELEY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:OR 13860 ST. STEPHENS AVE.
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518
Mailing Address - Country:US
Mailing Address - Phone:251-600-9119
Mailing Address - Fax:
Practice Address - Street 1:13860 ST STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:251-600-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach