Individual
SAMANTHA MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1708 PEACHTREE ST NW, ATLANTA, GA 30309-2434
(943) 300-4035
Mailing address
1708 PEACHTREE ST NW, ATLANTA, GA 30309-2434
(912) 312-0704
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134257827
—
GA
Enumeration date
08/23/2021
Last updated
02/24/2026
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