Provider Demographics
NPI:1376183632
Name:MALOCH, JACQUELINE ANNE (LCAS-R)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNE
Last Name:MALOCH
Suffix:
Gender:F
Credentials:LCAS-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TUNNEL RD STE F
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1869
Mailing Address - Country:US
Mailing Address - Phone:828-423-2669
Mailing Address - Fax:
Practice Address - Street 1:119 TUNNEL RD STE F
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1869
Practice Address - Country:US
Practice Address - Phone:828-423-2669
Practice Address - Fax:828-774-5726
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26098101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)