Provider Demographics
NPI:1881107035
Name:HORNER, MOLLY E (LSW, LICDC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:HORNER
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 HOPELAND ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3420
Mailing Address - Country:US
Mailing Address - Phone:937-535-5115
Mailing Address - Fax:
Practice Address - Street 1:257 HOPELAND ST BLDG A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3420
Practice Address - Country:US
Practice Address - Phone:937-535-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.22079571041C0700X
OHS.2001259-TRNE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical