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General NPI Number Information
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NPI Number | 1649402835
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Entity Type | Individual
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Provider Name | ANTHONY MALLACE MS
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Gender | Male
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 2699 STIRLING ROAD SUITE B304
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City | FT. LAUDERDALE
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State | FL
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Zip | 33312
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Country | US
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Telephone | 954-432-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 8320 NW 11TH COURT
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-432-8757
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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 | MH1149
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License Number State | FL
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