Healthcare Provider Details

I. General information

NPI: 1033862370
Provider Name (Legal Business Name): MOLLY HURST MA, LCMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19501 W CATAWBA AVE
CORNELIUS NC
28031-4017
US

IV. Provider business mailing address

6265 BRANCH HILL CIR
CHARLOTTE NC
28213-6405
US

V. Phone/Fax

Practice location:
  • Phone: 704-301-5424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA17214
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: