Healthcare Provider Details

I. General information

NPI: 1215212907
Provider Name (Legal Business Name): MS. MOLLY HILL MCCOBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 PIERCE ST
RICHMOND CA
94804-5910
US

IV. Provider business mailing address

2907 FULTON ST
BERKELEY CA
94705-1862
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-3009
  • Fax:
Mailing address:
  • Phone: 415-385-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number34836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: