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General NPI Number Information
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NPI Number | 1861890246
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Entity Type | Individual
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Provider Name | TAMIKA MALLARD I SOCIAL WORKER, BS
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Gender | Female
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 800 W OAKLAND PARK BLVD
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City | WILTON MANORS
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State | FL
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Zip | 33311-0916
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Country | US
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Telephone | 754-701-1197
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 NW 7TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-7611
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Country | US
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Telephone | 754-201-9855
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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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