Provider Demographics
NPI:1396766739
Name:MOLER, AMY GIVENS (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:GIVENS
Last Name:MOLER
Suffix:
Gender:F
Credentials:LPC
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 1183
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-1183
Mailing Address - Country:US
Mailing Address - Phone:540-674-4506
Mailing Address - Fax:540-674-4507
Practice Address - Street 1:125 BROAD STREET
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3201
Practice Address - Country:US
Practice Address - Phone:540-674-4506
Practice Address - Fax:540-674-4507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
178164OtherVALUE OPTIONS
VA01-0006571Medicaid
PA1000010001010788352OtherUNITED HEALTHCARE INSURANCE COMPANY
VA25180OtherCARILION SERVICES, INC
237585OtherANTHEM
MO276674-000OtherMAGELLAN
VA18377OtherVIRGINIA PREMIER HEALTH PLAN