NPI | 1134677248 |
---|---|
Former Name | LYNNE CHANTEL MALLORY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05717900) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00259900) |
Enumeration Date | 2016-09-17 |
Last Update Date | 2022-07-21 |