Healthcare Provider Details

I. General information

NPI: 1669232252
Provider Name (Legal Business Name): MOLLIE MCGARVEY-YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WINCHESTER AVE
MARTINSBURG WV
25401-1683
US

IV. Provider business mailing address

PO BOX 442
SHEPHERDSTOWN WV
25443-0442
US

V. Phone/Fax

Practice location:
  • Phone: 681-247-2281
  • Fax:
Mailing address:
  • Phone: 681-247-2281
  • Fax: 304-212-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: