Provider Demographics
NPI:1548398449
Name:MOODY, MALIKA (MSW)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 HIGHWAY 7 S
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-9129
Mailing Address - Country:US
Mailing Address - Phone:662-274-3220
Mailing Address - Fax:
Practice Address - Street 1:621 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-9129
Practice Address - Country:US
Practice Address - Phone:662-274-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical