Provider Demographics
NPI:1538395264
Name:MALINOWSKI, CHARLES JOSEPH (CAC/AD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MALINOWSKI
Suffix:
Gender:M
Credentials:CAC/AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7178 COLUMBIA GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2581
Mailing Address - Country:US
Mailing Address - Phone:410-313-6277
Mailing Address - Fax:410-313-6212
Practice Address - Street 1:7178 COLUMBIA GATEWAY DR.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2581
Practice Address - Country:US
Practice Address - Phone:410-313-6277
Practice Address - Fax:410-313-6212
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0454101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)