Countryman, Mollie

Countryman, Mollie is an sole proprietor health care provider with primary practice located at 323 N Broad St , Fairborn OH 45324-4934. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Countryman, Mollie can be contacted via phone (937) 318-8103.

Contact Information

Primary practice address
323 N Broad St Fairborn OH 45324-4934
Phone: (937) 318-8103
Fax: (937) 400-2347
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1194348334
LBN Legal business name Countryman, Mollie
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 22nd, 2020
Last updated May 25th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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