Provider Demographics
NPI:1861107096
Name:DIRKS, MOLLY (MHPR)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DIRKS
Suffix:
Gender:F
Credentials:MHPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 W SUPERIOR ST APT 305
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2013
Mailing Address - Country:US
Mailing Address - Phone:218-232-3509
Mailing Address - Fax:
Practice Address - Street 1:4720 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2634
Practice Address - Country:US
Practice Address - Phone:218-623-1800
Practice Address - Fax:218-623-1811
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health