Healthcare Provider Details

I. General information

NPI: 1194563049
Provider Name (Legal Business Name): MOLLY ROSSITER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MILLBRANCH RD STE 40
HATTIESBURG MS
39402-1673
US

IV. Provider business mailing address

32 MILLBRANCH RD STE 40
HATTIESBURG MS
39402-1673
US

V. Phone/Fax

Practice location:
  • Phone: 601-255-5264
  • Fax:
Mailing address:
  • Phone: 601-255-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number251006
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: