Provider Demographics
NPI:1245944602
Name:MOLINA, TERESA MARIE (ASW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 BELLFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2873
Mailing Address - Country:US
Mailing Address - Phone:619-948-8710
Mailing Address - Fax:
Practice Address - Street 1:1800 MAXWELL RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6158
Practice Address - Country:US
Practice Address - Phone:619-852-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker