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General NPI Number Information
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NPI Number | 1972047199
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Entity Type | Individual
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Provider Name | MOLLY ELIZABETH DWYER DEYTON LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 2209 9TH ST
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City | TUSCALOOSA
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State | AL
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Zip | 35401-2300
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Country | US
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Telephone | 205-391-3131
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Fax | 205-391-3137
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Provider Business Mailing Address
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Address Line | 2209 9TH STREET
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City | TUSCALOOSA
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State | AL
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Zip | 35401
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Country | US
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Telephone | 205-391-3131
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Fax | 205-391-3137
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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 | 3808C
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License Number State | AL
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