Healthcare Provider Details

I. General information

NPI: 1649277740
Provider Name (Legal Business Name): LOREN A MALKASIAN M.A.; LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHWAY 17 N STE 201
SURFSIDE BEACH SC
29575-6078
US

IV. Provider business mailing address

502 LUMBER ST
NICHOLS SC
29581-5074
US

V. Phone/Fax

Practice location:
  • Phone: 508-254-0066
  • Fax:
Mailing address:
  • Phone: 508-254-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC 4564
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4711
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: