Provider Demographics
NPI:1972651156
Name:MALLORY, ARMONDA L (MFT)
Entity Type:Individual
Prefix:MS
First Name:ARMONDA
Middle Name:L
Last Name:MALLORY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MONDI
Other - Middle Name:L
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:908 JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2993
Mailing Address - Country:US
Mailing Address - Phone:662-769-9439
Mailing Address - Fax:
Practice Address - Street 1:140 BRICKERTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-3608
Practice Address - Country:US
Practice Address - Phone:662-769-9439
Practice Address - Fax:662-368-8261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTO483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist