Provider Demographics
NPI:1073267597
Name:MALAVITE, LEILA MARIE (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:MARIE
Last Name:MALAVITE
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 SHAKER DR STE 113
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2351
Mailing Address - Country:US
Mailing Address - Phone:410-730-1499
Mailing Address - Fax:
Practice Address - Street 1:10450 SHAKER DR STE 113
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2351
Practice Address - Country:US
Practice Address - Phone:410-730-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist