Provider Demographics
NPI:1184978926
Name:MALLOY, TODD (MA, LMFT, CST, CSE)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:MALLOY
Suffix:
Gender:M
Credentials:MA, LMFT, CST, CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 REESE BLVD W
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7925
Mailing Address - Country:US
Mailing Address - Phone:704-659-2511
Mailing Address - Fax:704-659-2424
Practice Address - Street 1:13420 REESE BLVD W
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7925
Practice Address - Country:US
Practice Address - Phone:704-659-2511
Practice Address - Fax:704-659-2424
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8000A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist