Provider Demographics
NPI:1639461585
Name:MALONE, CAROLYN (LLPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4319
Mailing Address - Country:US
Mailing Address - Phone:989-753-8446
Mailing Address - Fax:989-753-2582
Practice Address - Street 1:210 COURT ST STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2358
Practice Address - Country:US
Practice Address - Phone:989-753-8446
Practice Address - Fax:989-753-2582
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011052101YP2500X
MI401011052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist