Provider Demographics
NPI:1043068224
Name:MOLINA, JO ANNA
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ANNA
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:FRANCISCA
Other - Last Name:CELESTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 S MELLONVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2228
Mailing Address - Country:US
Mailing Address - Phone:754-208-9710
Mailing Address - Fax:
Practice Address - Street 1:200 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3413
Practice Address - Country:US
Practice Address - Phone:754-208-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health