Provider Demographics
NPI:1154138220
Name:LIPSCOMB, MOLLY ANN (PRSS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2391
Mailing Address - Country:US
Mailing Address - Phone:304-696-4673
Mailing Address - Fax:
Practice Address - Street 1:1012 7TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2391
Practice Address - Country:US
Practice Address - Phone:304-696-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-947175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist