Provider Demographics
NPI:1679827364
Name:FORD, MALCOLM (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 GREENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5604
Mailing Address - Country:US
Mailing Address - Phone:916-541-3579
Mailing Address - Fax:
Practice Address - Street 1:7600 GREENHAVEN DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5604
Practice Address - Country:US
Practice Address - Phone:916-541-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)