Provider Demographics
NPI:1942692926
Name:MALCOM, TWYLA (LPC)
Entity type:Individual
Prefix:MS
First Name:TWYLA
Middle Name:
Last Name:MALCOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7789 KENNETT SQ
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5012
Mailing Address - Country:US
Mailing Address - Phone:248-949-0681
Mailing Address - Fax:
Practice Address - Street 1:43996 WOODWARD AVE STE 5
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5049
Practice Address - Country:US
Practice Address - Phone:248-876-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10630-125101YP2500X
MI6401017765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional