Provider Demographics
NPI:1104012632
Name:MOLINA, RACHEL KATE (LISW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:KATE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 LYNCH CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-2148
Mailing Address - Country:US
Mailing Address - Phone:505-242-6386
Mailing Address - Fax:505-281-9119
Practice Address - Street 1:8200 GUADALUPE TRL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1121
Practice Address - Country:US
Practice Address - Phone:505-898-3666
Practice Address - Fax:505-897-5165
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-058621041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool