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General NPI Number Information
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NPI Number | 1861097156
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Entity Type | Individual
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Provider Name | ANTHONY JAMES MALLIA MSCP
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Gender | Male
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 32100 TELEGRAPH RD STE 205
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-2454
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Country | US
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Telephone | 248-712-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 126 HOOP POLE CREEK DR
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City | ATLANTIC BEACH
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State | NC
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Zip | 28512-5812
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Country | US
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Telephone | 248-396-4861
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10235
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License Number State | SC
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