Healthcare Provider Details

I. General information

NPI: 1114511847
Provider Name (Legal Business Name): KATHLEEN HELEN MALONEY MA, LPA, HSP-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4397 FEDERAL DR
GREENSBORO NC
27410-8116
US

IV. Provider business mailing address

4397 FEDERAL DR
GREENSBORO NC
27410-8116
US

V. Phone/Fax

Practice location:
  • Phone: 336-496-2838
  • Fax: 336-450-4464
Mailing address:
  • Phone: 336-496-2838
  • Fax: 336-450-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6545
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: