Provider Demographics
NPI:1447530621
Name:GOLIGHTLY-MONDRAGON, SALINA (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SALINA
Middle Name:
Last Name:GOLIGHTLY-MONDRAGON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 E LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2020
Mailing Address - Country:US
Mailing Address - Phone:714-644-2970
Mailing Address - Fax:
Practice Address - Street 1:11870 PIERCE ST STE 200250
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-4402
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA636741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health