| Doctor Name: | MR. DOMINICK MOLLICA |
| NPI Number: | 1003256330 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA, MHP |
| License Number: | |
| Business Practice Address: | 101 S Jefferson St Woodstock, IL - 600983437 |
| Business Phone Number: | 8153387360 |
| Business Fax Number: | |
| Mailing Address: | 5417 Crossview Ln, LAKE IN THE HILLS |
| State: | IL |
| Postal Code: | 601565884 |
| Phone Number: | 8474004611 |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2013 |
| NPI Last Update Date: | 07/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |