Provider Demographics
NPI:1073390555
Name:MALAN, ALLISON DENISE ELDRIDGE (LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DENISE ELDRIDGE
Last Name:MALAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:DENISE
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:643 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:643 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4985
Practice Address - Country:US
Practice Address - Phone:707-391-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA1139411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical