MEDICARE: MOLLY LACROIX MAMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 51106	CA

General Provider Information

NPI Number	:	1073847992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY LACROIX MAMFT

Provider Business Mailing Address
First Line	:	3160 CAMINO DEL RIO S STE 304
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3835
Country	:	US
Telephone Number	:	619-819-0283
Fax Number	:	619-819-7579

Provider Business Practice Location Address
First Line	:	3160 CAMINO DEL RIO S STE 304
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3835
Country	:	US
Telephone Number	:	619-819-0283
Fax Number	:	619-819-7579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	03/07/2012

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Directions to “ MOLLY LACROIX MAMFT” Practice Location

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