Provider Demographics
NPI:1164255675
Name:MOLINA, CONNIE SUE (LCSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:SUE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2027 LOMA ALTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3300
Mailing Address - Country:US
Mailing Address - Phone:956-733-7180
Mailing Address - Fax:
Practice Address - Street 1:2027 LOMA ALTA DR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3300
Practice Address - Country:US
Practice Address - Phone:361-446-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX625581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical