Provider Demographics
NPI:1063247567
Name:MCCONAHAY, MOLLIE CAROLINE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:CAROLINE
Last Name:MCCONAHAY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:MOLLIE
Other - Middle Name:CAROLINE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1337 FORT JOHNSON RD APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8836
Mailing Address - Country:US
Mailing Address - Phone:567-203-2614
Mailing Address - Fax:
Practice Address - Street 1:150 ASHLEY AVE RM 318
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8907
Practice Address - Country:US
Practice Address - Phone:843-792-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLRD.2209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered