Basic Information
| Provider Information | |||||||||
| NPI: | 1760150189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALONE | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-IT, SAC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 GAMMON LN | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537192210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084178144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1015 GAMMON LN | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537192210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084178144 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2021 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4815-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.