Provider Demographics
NPI:1326752072
Name:MALONE, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MALONE
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:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21071-0093
Mailing Address - Country:US
Mailing Address - Phone:443-790-7494
Mailing Address - Fax:
Practice Address - Street 1:12114 LAMOTTES CT
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-4728
Practice Address - Country:US
Practice Address - Phone:443-977-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW20482386OtherSDAT
MDW20482386OtherSTATE OF MD