Provider Demographics
NPI:1659105948
Name:MOLINA, ALLYSON BAILEY (LPC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:BAILEY
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:BAILEY
Other - Last Name:GOODELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12923 KERRYDALE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5011
Mailing Address - Country:US
Mailing Address - Phone:571-320-5456
Mailing Address - Fax:
Practice Address - Street 1:2124 RICHMOND HWY STE 301
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7264
Practice Address - Country:US
Practice Address - Phone:540-701-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health