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General NPI Number Information
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NPI Number | 1740033372
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Entity Type | Individual
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Provider Name | MOLLY YOUNG RESIDENT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 3901 RUGBY RD
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City | FAIRFAX
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State | VA
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Zip | 22033-2202
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Country | US
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Telephone | 703-631-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 11201 RESTON STATION BLVD APT 608
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City | RESTON
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State | VA
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Zip | 20190-5474
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Country | US
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Telephone | 202-615-0486
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0704016339
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License Number State | VA
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