Provider Demographics
NPI:1982616900
Name:STALEY, MOLLY JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JEAN
Last Name:STALEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COOPER POINT RD SW
Mailing Address - Street 2:BUILDING # 18-B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1178
Mailing Address - Country:US
Mailing Address - Phone:360-352-1668
Mailing Address - Fax:360-705-1350
Practice Address - Street 1:1800 COOPER POINT RD SW
Practice Address - Street 2:BUILDING # 18-B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1178
Practice Address - Country:US
Practice Address - Phone:360-352-1668
Practice Address - Fax:360-705-1350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000059811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical