Provider Demographics
NPI:1114511847
Name:MALONEY, KATHLEEN HELEN (MA, LPA, HSP-PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HELEN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MA, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 FEDERAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8116
Mailing Address - Country:US
Mailing Address - Phone:336-496-2838
Mailing Address - Fax:336-450-4464
Practice Address - Street 1:4397 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8116
Practice Address - Country:US
Practice Address - Phone:336-496-2838
Practice Address - Fax:336-450-4464
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC6545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program