Healthcare Provider Details

I. General information

NPI: 1346302296
Provider Name (Legal Business Name): MARILYN MALCOLM M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 PAVILLON PL
MILL SPRING NC
28756-5809
US

IV. Provider business mailing address

799 W MILLS ST A
COLUMBUS NC
28722-8644
US

V. Phone/Fax

Practice location:
  • Phone: 828-694-2300
  • Fax: 828-694-2301
Mailing address:
  • Phone: 828-894-0293
  • Fax: 828-694-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC # 6859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: