Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2021009183 | MO |
NPI | 1023684297 |
---|---|
Provider Name | Adrionia Marie Molder |
First Address | Columbia, MO 65205-0056 |
Second Address | Columbia, MO 65211-2340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2021 |
Last Update Date | 28/05/2021 |