Provider Demographics
NPI:1124324926
Name:MCGOVERN, MOLLY MEGHAN (LMBT,NCTMB)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:MEGHAN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LMBT,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WASHINGTON RD.
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1941
Mailing Address - Country:US
Mailing Address - Phone:828-713-1620
Mailing Address - Fax:
Practice Address - Street 1:43 WASHINGTON RD.
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1941
Practice Address - Country:US
Practice Address - Phone:828-713-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2993171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor