Provider Demographics
NPI:1265835011
Name:MOLINA-MARSHALL, SANTA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SANTA
Middle Name:L
Last Name:MOLINA-MARSHALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SANTA
Other - Middle Name:L
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12002 HUNTERTON STREET.
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-537-6091
Mailing Address - Fax:
Practice Address - Street 1:1320 19TH STREET NW.
Practice Address - Street 2:THE SUNDERLAND BLDG. SUITE #200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:301-537-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500777421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical