Healthcare Provider Details

I. General information

NPI: 1255922852
Provider Name (Legal Business Name): MOLLY ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 BALTIMORE BLVD STE 403
WESTMINSTER MD
21157-6146
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 703
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone: 301-345-1022
  • Fax: 301-560-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP13419
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: