Provider Demographics
NPI:1770926438
Name:DAUGHERTY, MOLLY (PCC-S)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6874
Mailing Address - Country:US
Mailing Address - Phone:330-221-1229
Mailing Address - Fax:
Practice Address - Street 1:388 S MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1035
Practice Address - Country:US
Practice Address - Phone:330-543-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0701071-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor