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General NPI Number Information
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NPI Number | 1235099276
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Entity Type | Organization
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Legal Business Name | DR CRYSTAL MALLOY PHD LPC MAC CEAP LLC
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 174 SCHOLAR RD
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City | GUYTON
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State | GA
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Zip | 31312-6240
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Country | US
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Telephone | 337-396-5592
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Fax | 912-250-6025
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Provider Business Mailing Address
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Address Line | 174 SCHOLAR RD
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City | GUYTON
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State | GA
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Zip | 31312-6240
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Country | US
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Telephone | 337-396-5592
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Fax | 912-250-6025
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. CRYSTAL MALLOY
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Credential | PHD, LPC, MAC, CEAP
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Telephone | 337-396-5592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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