Healthcare Provider Details

I. General information

NPI: 1538800776
Provider Name (Legal Business Name): MOLLY J. GRIEST MMT, LPMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 04/03/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HAMILL RD STE 332
BALTIMORE MD
21210-1813
US

IV. Provider business mailing address

9086 LAMBSKIN LN
COLUMBIA MD
21045-2939
US

V. Phone/Fax

Practice location:
  • Phone: 443-676-8613
  • Fax:
Mailing address:
  • Phone: 443-676-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number00065
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: