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General NPI Number Information
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NPI Number | 1699070474
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Entity Type | Individual
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Provider Name | PAMELA HAYES MALKOFF MFT, ATR-BC, LPC,
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Gender | Female
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 3495 PIEDMONT RD NE STE 100
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City | ATLANTA
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State | GA
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Zip | 30305-1717
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Country | US
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Telephone | 818-836-1239
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 ESCHER LN SE
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City | MABLETON
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State | GA
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Zip | 30126-5763
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Country | US
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Telephone | 818-836-1239
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 46565
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 00113
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | TPMF286
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC013381
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License Number State | GA
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