Provider Demographics
NPI:1073137980
Name:MALONE, SANDRA (CADC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4135
Mailing Address - Country:US
Mailing Address - Phone:912-314-4433
Mailing Address - Fax:912-785-2008
Practice Address - Street 1:5 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4433
Practice Address - Country:US
Practice Address - Phone:912-515-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)