Provider Demographics
NPI:1164252821
Name:BARNES, MALINDA BLACK (CADC-T)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:BLACK
Last Name:BARNES
Suffix:
Gender:F
Credentials:CADC-T
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:GAIL
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:537 CRIMSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5206
Mailing Address - Country:US
Mailing Address - Phone:404-834-3747
Mailing Address - Fax:
Practice Address - Street 1:1233 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6399
Practice Address - Country:US
Practice Address - Phone:404-834-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)