Provider Demographics
NPI:1861194227
Name:MOLLENKOPF, HEIDI (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MOLLENKOPF
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 MCPHERSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4635
Mailing Address - Country:US
Mailing Address - Phone:252-619-2749
Mailing Address - Fax:
Practice Address - Street 1:1400 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4510
Practice Address - Country:US
Practice Address - Phone:252-331-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0180541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical