Provider Demographics
NPI:1720371578
Name:NORRIS, MALIA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MALIA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CORP 1485 S SEMORAN BLVD.
Mailing Address - Street 2:SUITE 1448
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:808-221-7005
Mailing Address - Fax:
Practice Address - Street 1:711 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5343
Practice Address - Country:US
Practice Address - Phone:352-334-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-1895104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker