MEDICARE: PATRICK MALLOY LPC, NCC

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	S4716	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141X2	OTHER	NC	BLUE CROSS BLUE SHIELD
2	0007494821	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295822922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK MALLOY LPC, NCC

Provider Business Mailing Address
First Line	:	3725 NATIONAL DR
Second Line	:	SUITE 220
City	:	RALEIGH
State	:	NC
Zip	:	27612-4879
Country	:	US
Telephone Number	:	919-781-8370
Fax Number	:	919-781-2266

Provider Business Practice Location Address
First Line	:	3725 NATIONAL DR
Second Line	:	SUITE 220
City	:	RALEIGH
State	:	NC
Zip	:	27612-4879
Country	:	US
Telephone Number	:	919-781-8370
Fax Number	:	919-781-2266

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	06/06/2023

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