Provider Demographics
NPI:1982491247
Name:GREEN, MOLLY (CD-L, CD-PIC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:CD-L, CD-PIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53741 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8013
Mailing Address - Country:US
Mailing Address - Phone:248-705-3795
Mailing Address - Fax:
Practice Address - Street 1:53741 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8013
Practice Address - Country:US
Practice Address - Phone:248-705-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula