Provider Demographics
NPI:1326219189
Name:RICHARD, MALAIKA JAMILA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MALAIKA
Middle Name:JAMILA
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MCCORMICK DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5326
Mailing Address - Country:US
Mailing Address - Phone:301-883-0866
Mailing Address - Fax:
Practice Address - Street 1:817 WOODROW STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205
Practice Address - Country:US
Practice Address - Phone:803-569-1789
Practice Address - Fax:803-462-4972
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC576000922101YM0800X
DCLC500802751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3000641104OtherWORKER'S COMP
SC322842Medicaid
SC3347Medicare PIN