Provider Demographics
NPI:1164013074
Name:MALCOM, GINGER VINCENT
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:VINCENT
Last Name:MALCOM
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 1:901 OLD MARS HILL HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8628
Mailing Address - Country:US
Mailing Address - Phone:833-489-4460
Mailing Address - Fax:
Practice Address - Street 1:901 OLD MARS HILL HWY STE 5
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8628
Practice Address - Country:US
Practice Address - Phone:833-489-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)