Healthcare Provider Details

I. General information

NPI: 1972456549
Provider Name (Legal Business Name): MALACHI GILLIHAN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 MARTIN LUTHER KING JR WAY
BERKELEY CA
94703-2133
US

IV. Provider business mailing address

1717 HOPKINS ST
BERKELEY CA
94707-2714
US

V. Phone/Fax

Practice location:
  • Phone: 707-599-9469
  • Fax:
Mailing address:
  • Phone: 707-599-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: