Provider Demographics
NPI:1801118807
Name:MALINCHOC FEDERINKO, NATALYA J (LPC)
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:J
Last Name:MALINCHOC FEDERINKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:J
Other - Last Name:FEDERINKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2019 RAMBLING RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1630
Mailing Address - Country:US
Mailing Address - Phone:269-345-0909
Mailing Address - Fax:269-345-4985
Practice Address - Street 1:2019 RAMBLING RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1630
Practice Address - Country:US
Practice Address - Phone:269-345-0909
Practice Address - Fax:269-345-4985
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health