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General NPI Number Information
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NPI Number | 1528893427
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Entity Type | Individual
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Provider Name | MALLORY ELIZABETH CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 2105 COMMERCE DR
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City | CAYCE
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State | SC
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Zip | 29033-1524
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Country | US
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Telephone | 803-796-6179
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Fax |
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Provider Business Mailing Address
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Address Line | 811 POLO RD APT 521
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City | COLUMBIA
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State | SC
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Zip | 29223-4426
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Country | US
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Telephone | 508-713-5695
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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