Provider Demographics
NPI:1194352856
Name:MALCOLM, WILLIAM (LISW-CP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8469
Mailing Address - Country:US
Mailing Address - Phone:516-384-6020
Mailing Address - Fax:
Practice Address - Street 1:118 CREEK BEND DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8469
Practice Address - Country:US
Practice Address - Phone:516-384-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC152141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical