Provider Demographics
NPI:1841656287
Name:MOLINA, RUBEN (MA)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15124 ATHEY LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-6230
Mailing Address - Country:US
Mailing Address - Phone:571-218-9027
Mailing Address - Fax:
Practice Address - Street 1:9720 CAPITAL CT STE 303
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2051
Practice Address - Country:US
Practice Address - Phone:833-382-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704007576101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor