Provider Demographics
NPI:1497467294
Name:MALLORY L CARY
Entity Type:Organization
Organization Name:MALLORY L CARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-472-3131
Mailing Address - Street 1:PO BOX 190905
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:31119
Mailing Address - Country:US
Mailing Address - Phone:770-237-9983
Mailing Address - Fax:833-811-8331
Practice Address - Street 1:10 N CLARENDON AVE STE B
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1165
Practice Address - Country:US
Practice Address - Phone:770-237-9983
Practice Address - Fax:833-811-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty