Provider Demographics
NPI:1679074272
Name:BISHOP, MALIA ANNE (MA)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:ANNE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-1531
Mailing Address - Country:US
Mailing Address - Phone:251-947-2240
Mailing Address - Fax:251-929-4213
Practice Address - Street 1:18311 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-3490
Practice Address - Country:US
Practice Address - Phone:251-947-2240
Practice Address - Fax:251-929-4213
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist