| 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 |