Provider Demographics
NPI:1346302296
Name:MALCOLM, MARILYN (MA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 W MILLS ST
Mailing Address - Street 2:A
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-8644
Mailing Address - Country:US
Mailing Address - Phone:828-894-0293
Mailing Address - Fax:828-694-2301
Practice Address - Street 1:241 PAVILLON PL
Practice Address - Street 2:
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756-5809
Practice Address - Country:US
Practice Address - Phone:828-694-2300
Practice Address - Fax:828-694-2301
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC # 6859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional