Healthcare Provider Details

I. General information

NPI: 1518060185
Provider Name (Legal Business Name): BOBBY LEE MALONE MS MSW AAMFT LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W 10TH ST SUITE D
ANNISTON AL
36201-5614
US

IV. Provider business mailing address

PO BOX 1016
ANNISTON AL
36202-1016
US

V. Phone/Fax

Practice location:
  • Phone: 256-770-7339
  • Fax: 256-770-7338
Mailing address:
  • Phone: 256-770-7339
  • Fax: 256-770-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number21
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: