Healthcare Provider Details

I. General information

NPI: 1073334652
Provider Name (Legal Business Name): MOLLY LAROCCO THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 COLONIAL AVE
NORFOLK VA
23517-1915
US

IV. Provider business mailing address

1851 EDGEWOOD AVE
NORFOLK VA
23503-3223
US

V. Phone/Fax

Practice location:
  • Phone: 330-310-5325
  • Fax:
Mailing address:
  • Phone: 330-310-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOLLY R LAROCCO
Title or Position: THERAPIST
Credential: LPC
Phone: 330-310-5325