Provider Demographics
NPI:1679899587
Name:MALLONEE, NICHOLAS MCRAE (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MCRAE
Last Name:MALLONEE
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Gender:M
Credentials:BA PSYCHOLOGY
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Mailing Address - Street 1:3440 AIRWAY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2065
Mailing Address - Country:US
Mailing Address - Phone:707-544-3299
Mailing Address - Fax:707-544-6837
Practice Address - Street 1:3440 AIRWAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2065
Practice Address - Country:US
Practice Address - Phone:707-544-3299
Practice Address - Fax:707-544-6837
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor