Provider Demographics
NPI:1730651977
Name:MALONE, MICHAEL A (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MALONE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SPRINGHEALTH CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2460
Mailing Address - Country:US
Mailing Address - Phone:904-945-4593
Mailing Address - Fax:
Practice Address - Street 1:1217 SPRINGHEALTH CT
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2460
Practice Address - Country:US
Practice Address - Phone:904-945-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH16615OtherLMHC