Healthcare Provider Details

I. General information

NPI: 1376274555
Provider Name (Legal Business Name): LAKELYN MALOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FOREST DR STE 400
COLUMBIA SC
29204-4010
US

IV. Provider business mailing address

333 W BUTLER ST
LEXINGTON SC
29072-2605
US

V. Phone/Fax

Practice location:
  • Phone: 843-993-7696
  • Fax:
Mailing address:
  • Phone: 803-714-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17224
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: