Provider Demographics
NPI:1841043973
Name:HEISS-LOCUM, MOLLY (LCSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HEISS-LOCUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:HEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:332 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1092
Mailing Address - Country:US
Mailing Address - Phone:423-290-1375
Mailing Address - Fax:
Practice Address - Street 1:332 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1092
Practice Address - Country:US
Practice Address - Phone:423-290-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical