Provider Demographics
NPI:1881736429
Name:MALONE, JANICE (LPEI)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LPEI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHADY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3306
Mailing Address - Country:US
Mailing Address - Phone:501-351-4965
Mailing Address - Fax:
Practice Address - Street 1:1401 W CAPITOL AVE STE 330
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2953
Practice Address - Country:US
Practice Address - Phone:501-730-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86-18EI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling