Provider Demographics
NPI:1922452234
Name:TERRY, MOLLY RAE (LMHC-D)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:RAE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LMHC-D
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:RAE
Other - Last Name:THEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5651 MAIN ST STE 8-314
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5569
Mailing Address - Country:US
Mailing Address - Phone:716-275-0975
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5781
Practice Address - Country:US
Practice Address - Phone:716-275-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007171-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health