Provider Demographics
NPI:1487148276
Name:MALONEY, DEIDRE L (LPC, MS, LICDC, QMHS)
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:L
Last Name:MALONEY
Suffix:
Gender:F
Credentials:LPC, MS, LICDC, QMHS
Other - Prefix:MISS
Other - First Name:DEIDRE
Other - Middle Name:LATOIA
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4977 NORTHCUTT PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3839
Mailing Address - Country:US
Mailing Address - Phone:937-387-6395
Mailing Address - Fax:
Practice Address - Street 1:4977 NORTHCUTT PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3839
Practice Address - Country:US
Practice Address - Phone:937-387-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161726101YA0400X
251S00000X
OHC.2406575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health