Provider Demographics
NPI:1699290940
Name:MACIAS, LORENA MARIA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:MARIA
Last Name:MACIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LORENA
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 MIMOSA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-8055
Mailing Address - Country:US
Mailing Address - Phone:831-801-5258
Mailing Address - Fax:
Practice Address - Street 1:1152 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5218
Practice Address - Country:US
Practice Address - Phone:831-899-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health