Provider Demographics
NPI:1043825094
Name:MALCOLM, CHRISTA DEEANNE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:DEEANNE
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 HARNETT CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1966
Mailing Address - Country:US
Mailing Address - Phone:931-614-7397
Mailing Address - Fax:931-443-0079
Practice Address - Street 1:2031 N MOUNT JULIET RD STE 201
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4498
Practice Address - Country:US
Practice Address - Phone:615-438-3615
Practice Address - Fax:931-443-0079
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health