Provider Demographics
NPI:1043965783
Name:MALONE, MARY BETH (BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MALONE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 WHISPER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9399
Mailing Address - Country:US
Mailing Address - Phone:205-516-9663
Mailing Address - Fax:
Practice Address - Street 1:23 WHISPER LAKE DR
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-9399
Practice Address - Country:US
Practice Address - Phone:205-516-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst