Healthcare Provider Details

I. General information

NPI: 1073235115
Provider Name (Legal Business Name): MOLLY DREAM WEAVER LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY WEAVER

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 WISCONSIN AVE NW STE 300
WASHINGTON DC
20016-4606
US

IV. Provider business mailing address

4530 WISCONSIN AVE NW STE 300
WASHINGTON DC
20016-4606
US

V. Phone/Fax

Practice location:
  • Phone: 202-536-4414
  • Fax:
Mailing address:
  • Phone: 202-536-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200012550
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: