Provider Demographics
NPI:1306153622
Name:MOLINA, LYNNEA GIBRONNE
Entity type:Individual
Prefix:
First Name:LYNNEA
Middle Name:GIBRONNE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 LAGUNA WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2818
Mailing Address - Country:US
Mailing Address - Phone:518-588-0207
Mailing Address - Fax:
Practice Address - Street 1:3316 LAGUNA WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2818
Practice Address - Country:US
Practice Address - Phone:518-588-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2024-10-23
Deactivation Date:2024-09-23
Deactivation Code:
Reactivation Date:2024-10-22
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA814511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health