Healthcare Provider Details

I. General information

NPI: 1508174913
Provider Name (Legal Business Name): JAMI ALLISON MALONEY MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMI ALLISON EKSTROM MSW, ASW

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N NORMA ST
RIDGECREST CA
93555-2575
US

IV. Provider business mailing address

1400 N NORMA ST
RIDGECREST CA
93555-2575
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-7406
  • Fax: 760-499-9259
Mailing address:
  • Phone: 760-499-7406
  • Fax: 760-499-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW29737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: