Individual
MS. MARJORIE MALONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPCC
Contact information
Practice address
413 SIPAPU ROAD, 6952, TAOS, NM 87571
(575) 758-5857
(575) 758-2832
Mailing address
PO BOX 2070, 209 LAS CRUCES LANE, TAOS, NM 87571-2070
(505) 758-1565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CSAC II 169
CA
101YM0800X
Mental Health Counselor
LPCC 96621
NM
101YP2500X
Professional Counselor
Primary
0096621
NM
101YP2500X
Professional Counselor
LPCC 96621
NM
102L00000X
Psychoanalyst
LMFT 43969
CA
102L00000X
Psychoanalyst
LPCC 96621
NM
106H00000X
Marriage & Family Therapist
LMFT 43969
CA
Other
Enumeration date
10/24/2007
Last updated
07/23/2009
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