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General NPI Number Information
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NPI Number | 1083415913
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Entity Type | Individual
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Provider Name | DEANDRA MALONE
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 3341 YOUREE DR STE 10B
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City | SHREVEPORT
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State | LA
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Zip | 71105-2149
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Country | US
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Telephone | 318-675-0804
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Fax | 318-779-1867
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Provider Business Mailing Address
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Address Line | 1000 CHINABERRY DR STE 900
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2455
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Country | US
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Telephone | 318-459-6795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12872
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License Number State | LA
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