Provider Demographics
NPI:1619923166
Name:MALONE, CHRISTINE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11585 CHARLESBASS CV
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-6919
Mailing Address - Country:US
Mailing Address - Phone:901-867-7480
Mailing Address - Fax:
Practice Address - Street 1:554 GREEN TREE CV STE 101A
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2551
Practice Address - Country:US
Practice Address - Phone:901-619-7173
Practice Address - Fax:901-754-9279
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS34-557103TC1900X
TNP1962103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3687512Medicare PIN
MS680000292Medicare PIN