MEDICARE: MOLLY MARTIN

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811721186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY MARTIN

Provider Business Mailing Address
First Line	:	1400 AMBERTON WAY
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6938
Country	:	US
Telephone Number	:	678-993-8231
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW STE G5
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4653
Country	:	US
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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Directions to “ MOLLY MARTIN ” Practice Location

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