Provider Information for 1417194911
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Mrs. VICTORIA MALONE-MARION LISW-S, LICDC
Sex: Female
NPI: 1417194911
Last Updated: 2020-04-14
Certification Date: 2020-04-14
Certification Date: 2020-04-14
Details
| Name | Value | ||||||||||||
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| NPI | 1417194911 | ||||||||||||
| Enumeration Date | 2009-01-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6805 MAYFIELD RD 1024 CLEVELAND, OH 44124-2272 United States Phone: 216-269-1180 | Fax: | ||||||||||||
| Primary Practice Address | 10701 EAST BLVD CLEVELAND, OH 44106-1702 United States Phone: 216-391-0264 | Fax: | ||||||||||||
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