Provider Demographics
NPI:1225325665
Name:MALONE, TAMBRA (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMBRA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 VARVAROSKY RD
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9378
Mailing Address - Country:US
Mailing Address - Phone:318-446-1539
Mailing Address - Fax:
Practice Address - Street 1:1414 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:GLENMORA
Practice Address - State:LA
Practice Address - Zip Code:71433
Practice Address - Country:US
Practice Address - Phone:318-748-8974
Practice Address - Fax:318-748-8986
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical