Provider Demographics
NPI:1265593529
Name:MOLLOY, LEAH CARTER (LPC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:CARTER
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 NATOMA CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-9303
Mailing Address - Country:US
Mailing Address - Phone:404-518-9408
Mailing Address - Fax:
Practice Address - Street 1:11675 CENTURY DR UNIT C
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8367
Practice Address - Country:US
Practice Address - Phone:678-740-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001247101YP2500X
GA005450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional