Provider Demographics
NPI:1326408006
Name:MOLINA, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MOLINA
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 1:8466 W PEORIA AVE
Mailing Address - Street 2:#6
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6548
Mailing Address - Country:US
Mailing Address - Phone:623-466-7233
Mailing Address - Fax:623-399-6377
Practice Address - Street 1:8466 W PEORIA AVE
Practice Address - Street 2:#6
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6548
Practice Address - Country:US
Practice Address - Phone:623-466-7233
Practice Address - Fax:623-399-6377
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-01281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical