Provider Demographics
NPI:1720680820
Name:MOLLETT, REGINA R
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:R
Last Name:MOLLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N FREMONT AVE APT B2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3258
Mailing Address - Country:US
Mailing Address - Phone:412-853-6142
Mailing Address - Fax:
Practice Address - Street 1:16 N FREMONT AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3228
Practice Address - Country:US
Practice Address - Phone:412-853-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)