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General NPI Number Information
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NPI Number | 1588384770
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Entity Type | Individual
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Provider Name | MOLLY ROSE ISLES CADAC II
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 500 FARRINGTON ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-5095
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Country | US
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Telephone | 812-917-0068
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Fax |
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Provider Business Mailing Address
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Address Line | 4535 YUMA RD
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City | WEST TERRE HAUTE
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State | IN
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Zip | 47885-9654
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Country | US
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Telephone | 765-505-3156
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C2-51270
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License Number State | IN
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