Provider Demographics
NPI:1366069049
Name:MCCONNELL, MALARIE CATHERINE
Entity type:Individual
Prefix:
First Name:MALARIE
Middle Name:CATHERINE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 EARLE RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-8001
Mailing Address - Country:US
Mailing Address - Phone:843-593-6962
Mailing Address - Fax:
Practice Address - Street 1:2032 CARL MEARES RD
Practice Address - Street 2:
Practice Address - City:FAIR BLUFF
Practice Address - State:NC
Practice Address - Zip Code:28439-9787
Practice Address - Country:US
Practice Address - Phone:813-763-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-18-72849106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician