Provider Demographics
NPI:1457955387
Name:MOLENKAMP, RENE JOHN (LPCC)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:JOHN
Last Name:MOLENKAMP
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 SANTA MONICA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2930
Mailing Address - Country:US
Mailing Address - Phone:619-519-0463
Mailing Address - Fax:
Practice Address - Street 1:4323 SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2930
Practice Address - Country:US
Practice Address - Phone:619-519-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC8787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional