| NPI | 1043825094 |
|---|---|
| Former Name | CHRISTA DEEANNE MALCOLM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015668) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0701015668) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2026-05-01 |