Provider Demographics
NPI:1689191371
Name:MOLINA, KIRA K (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:K
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S PENDLETON DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2024
Mailing Address - Country:US
Mailing Address - Phone:719-821-9605
Mailing Address - Fax:
Practice Address - Street 1:61 S PENDLETON DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2024
Practice Address - Country:US
Practice Address - Phone:719-821-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001261101YA0400X
COCSW.099262001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)