Provider Demographics
NPI:1447783121
Name:ENGLISH, MALLORY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MADISON ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4735
Mailing Address - Country:US
Mailing Address - Phone:443-676-9759
Mailing Address - Fax:
Practice Address - Street 1:104 W MADISON ST APT 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4735
Practice Address - Country:US
Practice Address - Phone:443-676-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional