Healthcare Provider Details

I. General information

NPI: 1386936219
Provider Name (Legal Business Name): MR. WILLIAM H. MALONEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 BAY RIDGE CT
LAWRENCEVILLE GA
30045-8673
US

IV. Provider business mailing address

PO BOX 876
GRAYSON GA
30017-0016
US

V. Phone/Fax

Practice location:
  • Phone: 843-908-1479
  • Fax:
Mailing address:
  • Phone: 843-908-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number782311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: