Healthcare Provider Details

I. General information

NPI: 1083243810
Provider Name (Legal Business Name): MOLLIE BROWNE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 ROAD ATLANTA
BLOOMINGDALE GA
31302-4856
US

IV. Provider business mailing address

287 ROAD ATLANTA
BLOOMINGDALE GA
31302-4856
US

V. Phone/Fax

Practice location:
  • Phone: 720-828-2894
  • Fax:
Mailing address:
  • Phone: 720-828-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0002057
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: