Provider Demographics
NPI:1699453597
Name:MOLINA, MARIA P (MSWC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:P
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 TOMAH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6968
Mailing Address - Country:US
Mailing Address - Phone:719-642-8564
Mailing Address - Fax:
Practice Address - Street 1:5350 TOMAH DR STE 3600
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6991
Practice Address - Country:US
Practice Address - Phone:888-316-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COSWC.00000005771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health