Provider Demographics
NPI:1548652795
Name:LARSON, MOLLY (PHD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 BRIARCLIFF ROAD NE
Mailing Address - Street 2:15
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306
Mailing Address - Country:US
Mailing Address - Phone:678-637-2482
Mailing Address - Fax:
Practice Address - Street 1:140 DECATUR ST SE
Practice Address - Street 2:1053
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3204
Practice Address - Country:US
Practice Address - Phone:404-413-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical