Provider Demographics
NPI:1780575985
Name:NEILL ROGERS, MALLORY GENINE
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:GENINE
Last Name:NEILL ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MALLORY
Other - Middle Name:GENINE
Other - Last Name:NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1037 ROYAL OAK RD NW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4207
Mailing Address - Country:US
Mailing Address - Phone:704-402-7140
Mailing Address - Fax:
Practice Address - Street 1:2520 TROY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7661
Practice Address - Country:US
Practice Address - Phone:910-762-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)