Healthcare Provider Details

I. General information

NPI: 1639405459
Provider Name (Legal Business Name): MELVIN E MALONE JR. M.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR COTTAGE A
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

1800 COLONIAL DR # A
COLUMBIA SC
29203-6827
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-1306
  • Fax:
Mailing address:
  • Phone: 803-898-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: