Provider Demographics
NPI:1972734846
Name:MADDOX, MOLLY PLUMMER (LMFT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:PLUMMER
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SHUSTER RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-7766
Mailing Address - Country:US
Mailing Address - Phone:724-265-7832
Mailing Address - Fax:
Practice Address - Street 1:58 SHUSTER RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-7766
Practice Address - Country:US
Practice Address - Phone:724-265-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YS0200X
PAMF000185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool