Provider Demographics
NPI:1053881904
Name:MOLI PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:MOLI PEDIATRIC THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:LIPPOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:757-301-2411
Mailing Address - Street 1:2008 GENERAL BOOTH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5910
Mailing Address - Country:US
Mailing Address - Phone:757-803-5663
Mailing Address - Fax:888-966-0621
Practice Address - Street 1:2008 GENERAL BOOTH BLVD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5910
Practice Address - Country:US
Practice Address - Phone:757-301-2411
Practice Address - Fax:888-966-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty