Provider Demographics
NPI:1649803594
Name:BERNARD, MALCOLM IAN (LPC)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:IAN
Last Name:BERNARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 BATTERY AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5107
Mailing Address - Country:US
Mailing Address - Phone:540-709-1778
Mailing Address - Fax:540-227-7050
Practice Address - Street 1:1320 CENTRAL PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4953
Practice Address - Country:US
Practice Address - Phone:540-709-1778
Practice Address - Fax:540-227-7050
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional