Provider Demographics
NPI:1740478916
Name:MALONE, FARMER III (CADC)
Entity type:Individual
Prefix:MR
First Name:FARMER
Middle Name:
Last Name:MALONE
Suffix:III
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WHETSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3619
Mailing Address - Country:US
Mailing Address - Phone:502-244-5202
Mailing Address - Fax:
Practice Address - Street 1:1013 WHETSTONE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3619
Practice Address - Country:US
Practice Address - Phone:502-244-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)