Provider Demographics
NPI:1649568643
Name:MALIA, EVA MARIA (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:EVA
Middle Name:MARIA
Last Name:MALIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SHIRLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3327
Mailing Address - Country:US
Mailing Address - Phone:801-541-3186
Mailing Address - Fax:
Practice Address - Street 1:150 CHESTNUT ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4645
Practice Address - Country:US
Practice Address - Phone:401-680-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health