MEDICARE: MALLORY ALYSSE SIMMONS LGPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LGP10103	MD

General Provider Information

NPI Number	:	1215682042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY ALYSSE SIMMONS LGPC

Provider Business Mailing Address
First Line	:	327 E RIDGEVILLE BLVD # 312
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5201
Country	:	US
Telephone Number	:	202-750-1028
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 JOSEPH CT
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774
Country	:	US
Telephone Number	:	202-750-1028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/21/2022

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