=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972651156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARMONDA L. MALLORY M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2007
-----------------------------------------------------
Last Update Date | 08/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 BRICKERTON ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39701-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-769-9439
-----------------------------------------------------
Fax | 662-368-8261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 JOLLY RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39705-2993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-769-9439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | TO483
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------