Provider Demographics
NPI:1679030308
Name:SMITH, MALLORY KROLIKOWSKI (MT-BC, LPCC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:KROLIKOWSKI
Last Name:SMITH
Suffix:
Gender:F
Credentials:MT-BC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21430 LORAIN RD STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2148
Mailing Address - Country:US
Mailing Address - Phone:216-200-8814
Mailing Address - Fax:
Practice Address - Street 1:21430 LORAIN RD STE 400
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2148
Practice Address - Country:US
Practice Address - Phone:216-200-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901605-TRNE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional