Healthcare Provider Details

I. General information

NPI: 1619923166
Provider Name (Legal Business Name): CHRISTINE MARIE MALONE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 GREEN TREE CV STE 101A
COLLIERVILLE TN
38017-2551
US

IV. Provider business mailing address

11585 CHARLESBASS CV
EADS TN
38028-6919
US

V. Phone/Fax

Practice location:
  • Phone: 901-619-7173
  • Fax: 901-754-9279
Mailing address:
  • Phone: 901-867-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34-557
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP1962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: