Healthcare Provider Details

I. General information

NPI: 1962186916
Provider Name (Legal Business Name): MOLLY SANTIN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11270 E 13 MILE RD STE 2
WARREN MI
48093-2599
US

IV. Provider business mailing address

27 NAKOTA ST
CLAWSON MI
48017-2048
US

V. Phone/Fax

Practice location:
  • Phone: 586-991-1052
  • Fax:
Mailing address:
  • Phone: 248-918-9487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: