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General NPI Number Information
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NPI Number | 1124824461
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Entity Type | Individual
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Provider Name | MS. GABRIELLA ALEXZANDRIA MALLORY
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 2470 COLLINGWOOD ST STE 217
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City | DETROIT
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State | MI
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Zip | 48206-1500
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Country | US
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Telephone | 248-884-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 19206 GRANDVIEW ST
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City | DETROIT
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State | MI
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Zip | 48219-1693
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Country | US
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Telephone | 313-675-3426
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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