Provider Demographics
NPI:1982293585
Name:MACDONALD, MALLORY KATE (LCMHC, LCASA, NCC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:KATE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LCMHC, LCASA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5202
Mailing Address - Country:US
Mailing Address - Phone:252-497-2796
Mailing Address - Fax:
Practice Address - Street 1:790 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5202
Practice Address - Country:US
Practice Address - Phone:252-497-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16269101YM0800X
NCLCAS-26906101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)