Healthcare Provider Details

I. General information

NPI: 1336612811
Provider Name (Legal Business Name): MOLLY G OLLIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 HAILEY DR
CENTERTON AR
72719-8912
US

IV. Provider business mailing address

219 HAILEY DR
CENTERTON AR
72719-8912
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax: 501-526-5148
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10231-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: