Provider Demographics
NPI:1003582875
Name:MALAK, ELIZABETH VEACH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VEACH
Last Name:MALAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2108
Mailing Address - Country:US
Mailing Address - Phone:704-654-8828
Mailing Address - Fax:
Practice Address - Street 1:2300 E 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3314
Practice Address - Country:US
Practice Address - Phone:704-774-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health