Provider Demographics
NPI:1265406938
Name:SMITH, MOLLY A (LPCC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:A
Other - Last Name:FAIRCHILD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0817
Mailing Address - Country:US
Mailing Address - Phone:937-465-8065
Mailing Address - Fax:937-465-0442
Practice Address - Street 1:118 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-599-1975
Practice Address - Fax:937-599-2769
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004103101YP2500X
OHE.0004103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional