Healthcare Provider Details

I. General information

NPI: 1598894123
Provider Name (Legal Business Name): GRACE M. MALONAI PHD, LPCC, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 MORAGA RD
LAFAYETTE CA
94549-4423
US

IV. Provider business mailing address

986 MORAGA RD
LAFAYETTE CA
94549-4423
US

V. Phone/Fax

Practice location:
  • Phone: 259-546-2299
  • Fax: 925-269-8052
Mailing address:
  • Phone: 925-954-6229
  • Fax: 925-269-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC 252
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: