Provider Demographics
NPI:1982947933
Name:MALCOLM, MICHAL (MA)
Entity Type:Individual
Prefix:MRS
First Name:MICHAL
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3321
Mailing Address - Country:US
Mailing Address - Phone:407-409-3049
Mailing Address - Fax:
Practice Address - Street 1:132 DUBLIN DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3321
Practice Address - Country:US
Practice Address - Phone:407-409-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health