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General NPI Number Information
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NPI Number | 1104770304
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Entity Type | Individual
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Provider Name | MOLLY NICOLE SEPULVADO LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 3101 WILSON BLVD FL 5
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City | ARLINGTON
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State | VA
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Zip | 22201-4443
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Country | US
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Telephone | 703-772-5097
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Fax |
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Provider Business Mailing Address
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Address Line | 8019 GREELEY BLVD
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City | SPRINGFIELD
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State | VA
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Zip | 22152-3039
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Country | US
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Telephone | 913-306-2861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904019971
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License Number State | VA
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