Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | 6387 | SC |
N | 101YP2500X | Professional Counselor | 6387 | SC |
NPI | 1003124884 |
---|---|
Provider Name | Paul Malkasian |
First Address | Myrtle Beach, SC 29577-3216 |
Second Address | Murrells Inlet, SC 29576-5240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 17/03/2018 |