Healthcare Provider Details

I. General information

NPI: 1699612754
Provider Name (Legal Business Name): LAICEE MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7593 TYLERS PLACE BLVD
WEST CHESTER OH
45069-6308
US

IV. Provider business mailing address

115 N SUTPHIN ST
MIDDLETOWN OH
45042-3220
US

V. Phone/Fax

Practice location:
  • Phone: 513-714-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPRS.007760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: