Provider Demographics
NPI:1760002927
Name:MOLINA, ANGELA MARIA (LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11932 FAIRWAY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8337
Mailing Address - Country:US
Mailing Address - Phone:239-237-2801
Mailing Address - Fax:
Practice Address - Street 1:11932 FAIRWAY LAKES DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8337
Practice Address - Country:US
Practice Address - Phone:239-237-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty