Provider Demographics
NPI:1649392234
Name:MOLINA BROOKINS, MARYANN RUTH (CSAC II, CADC II)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:RUTH
Last Name:MOLINA BROOKINS
Suffix:
Gender:F
Credentials:CSAC II, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428-0508
Mailing Address - Country:US
Mailing Address - Phone:707-983-6648
Mailing Address - Fax:707-983-6649
Practice Address - Street 1:23000 HENDERSON LN.
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428
Practice Address - Country:US
Practice Address - Phone:707-983-6648
Practice Address - Fax:707-983-6649
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA840401101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)