Healthcare Provider Details

I. General information

NPI: 1366362550
Provider Name (Legal Business Name): MOLLY ANNE TODD LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3143 S STRATFORD RD
WINSTON SALEM NC
27103-5948
US

IV. Provider business mailing address

2301 ROSEWOOD AVE
WINSTON SALEM NC
27103-3638
US

V. Phone/Fax

Practice location:
  • Phone: 336-893-9705
  • Fax:
Mailing address:
  • Phone: 727-871-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23171
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: