Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813001104 | VA |
N | 106S00000X | Behavior Technician |
NPI | 1073155487 |
---|---|
Provider Name | Molly Midkiff |
First Address | Midlothian, VA 23112-2004 |
Second Address | Midlothian, VA 23112-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2019 |
Last Update Date | 31/08/2020 |