MEDICARE: MOLLY ELIZABETH BLEMKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704017367	VA

General Provider Information

NPI Number	:	1255158580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY ELIZABETH BLEMKER

Provider Business Mailing Address
First Line	:	632 FARNHAM CIR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4173
Country	:	US
Telephone Number	:	804-938-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	3108 SEMMES AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3759
Country	:	US
Telephone Number	:	804-255-9597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ MOLLY ELIZABETH BLEMKER ” Practice Location

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