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NPI Code Detail

MEDICARE: MANDY JO MOLDEHNKE

MEDICARE: MANDY JO MOLDEHNKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health CounselorA8713NC

General Provider Information

NPI Number : 1568661619
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY JO MOLDEHNKE
Provider Business Mailing Address
First Line : 4415 MONROE RD
Second Line : SUITE 100
City : CHARLOTTE
State : NC
Zip : 28205-7754
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4415 MONROE RD
Second Line : SUITE 100
City : CHARLOTTE
State : NC
Zip : 28205-7754
Country : US
Telephone Number : 704-332-3634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2007
Last Update Date : 01/16/2013

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