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General NPI Number Information
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NPI Number | 1104645928
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Entity Type | Individual
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Provider Name | CHASITY MALLORY
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Gender | Female
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2479 ALOMA AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-2541
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Country | US
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Telephone | 407-657-6692
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Fax |
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Provider Business Mailing Address
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Address Line | 520 REFLECTIONS CIRCLE APT 207
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City | CASSELBERRY
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State | FL
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Zip | 32707
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Country | US
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Telephone | 470-998-1751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB1144930
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License Number State |
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