Healthcare Provider Details

I. General information

NPI: 1154937217
Provider Name (Legal Business Name): TRICIA MALONE LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 COSHOCTON AVE STE A
MOUNT VERNON OH
43050-1900
US

IV. Provider business mailing address

15485 MILLERSBURG RD
DANVILLE OH
43014-9601
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-6110
  • Fax: 800-480-7578
Mailing address:
  • Phone: 740-485-3042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162614
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: