Healthcare Provider Details

I. General information

NPI: 1639016462
Provider Name (Legal Business Name): GIANNA MALCOLM-LAVALAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FRANDORSON CIR STE 200
APOLLO BEACH FL
33572-2691
US

IV. Provider business mailing address

11336 BRIGHTON KNOLL LOOP
RIVERVIEW FL
33579-2113
US

V. Phone/Fax

Practice location:
  • Phone: 908-337-6702
  • Fax:
Mailing address:
  • Phone: 908-337-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: