Individual
MOLLY ROSE ISLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADAC II
Contact information
Practice address
500 FARRINGTON ST, TERRE HAUTE, IN 47807-5095
(812) 917-0068
Mailing address
4535 YUMA RD, WEST TERRE HAUTE, IN 47885-9654
(765) 505-3156
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C2-51270
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C2-51270
—
IN
Enumeration date
08/30/2022
Last updated
08/30/2022
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