Provider Demographics
NPI:1740033372
Name:YOUNG, MOLLY (RESIDENT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 RESTON STATION BLVD APT 608
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5474
Mailing Address - Country:US
Mailing Address - Phone:202-615-0486
Mailing Address - Fax:
Practice Address - Street 1:3901 RUGBY RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2202
Practice Address - Country:US
Practice Address - Phone:703-631-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional