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General NPI Number Information
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NPI Number | 1548835226
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Entity Type | Individual
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Provider Name | SAMANTHA MALLONI LCDCIII
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 120 MAY DR
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City | HARRISON
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State | OH
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Zip | 45030-2024
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Country | US
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Telephone | 513-738-7600
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Fax | 513-738-7601
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Provider Business Mailing Address
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Address Line | 3621 ROSSGATE CT
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City | HAMILTON
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State | OH
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Zip | 45013-9558
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Country | US
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Telephone | 513-738-7600
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Fax | 513-738-7601
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.176222
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.162371
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License Number State | OH
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