Provider Demographics
NPI:1245810472
Name:MALCHUK, ALAN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:MALCHUK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 LAKE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8409
Mailing Address - Country:US
Mailing Address - Phone:336-712-2828
Mailing Address - Fax:
Practice Address - Street 1:4217 LAKE CLIFF DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8409
Practice Address - Country:US
Practice Address - Phone:336-712-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC002865OtherNC SOCIAL WORK CERTIFICATION AND LICENSURE BOARD