Provider Demographics
NPI:1942790142
Name:REED, MALLORY TAYLOR (BS)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:TAYLOR
Last Name:REED
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 BOBWHITE LN
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-2871
Mailing Address - Country:US
Mailing Address - Phone:843-307-7213
Mailing Address - Fax:
Practice Address - Street 1:709 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4738
Practice Address - Country:US
Practice Address - Phone:803-432-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)