Provider Demographics
NPI:1598875502
Name:ADKINS, MALINDA SHONDALE (MA)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:SHONDALE
Last Name:ADKINS
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 1:5320 EASTERN KENTUCKY OUTPATIENT CLINIC
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-886-1970
Mailing Address - Fax:606-886-3668
Practice Address - Street 1:5320 KY ROUTE 321 SUITE 8
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-886-1970
Practice Address - Fax:606-886-3668
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
KY33921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist