Provider Demographics
NPI:1356840557
Name:MOONEY, MALIK (LPC)
Entity Type:Individual
Prefix:MR
First Name:MALIK
Middle Name:
Last Name:MOONEY
Suffix:
Gender:M
Credentials:LPC
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 291502
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0026
Mailing Address - Country:US
Mailing Address - Phone:803-626-2256
Mailing Address - Fax:
Practice Address - Street 1:1 WINDSOR CV
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1833
Practice Address - Country:US
Practice Address - Phone:803-873-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6672OtherBOARD OF EXAMINERS FOR COUNSELORS, THERAPISTS, & PSYCHO-EDUCATIONAL SPECIALISTS