Provider Demographics
NPI:1104191956
Name:MOLINA-WITCRAFT, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:MOLINA-WITCRAFT
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 1:217 S K ST
Mailing Address - Street 2:23
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4655
Mailing Address - Country:US
Mailing Address - Phone:559-481-0781
Mailing Address - Fax:
Practice Address - Street 1:1235 E ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2024
Practice Address - Country:US
Practice Address - Phone:559-268-6261
Practice Address - Fax:559-268-7518
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)