Provider Demographics
NPI:1245099068
Name:MOLINA, BLANCANDREA QUETZALI (LPCC)
Entity type:Individual
Prefix:
First Name:BLANCANDREA
Middle Name:QUETZALI
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SMITH LN
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9162
Mailing Address - Country:US
Mailing Address - Phone:808-457-8257
Mailing Address - Fax:
Practice Address - Street 1:2210 SMITH LN
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451-9162
Practice Address - Country:US
Practice Address - Phone:808-457-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC15659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health