Provider Demographics
NPI:1750056396
Name:MALAVE, LORENA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MALAVE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 WIEUCA RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3847
Mailing Address - Country:US
Mailing Address - Phone:762-685-3623
Mailing Address - Fax:
Practice Address - Street 1:4116 WIEUCA RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3847
Practice Address - Country:US
Practice Address - Phone:762-685-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007050101YM0800X
GALPC013311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health