Provider Demographics
NPI:1982296844
Name:LAMM, MALLORY (LICSW)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:LAMM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 OLD ROCKY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5343
Mailing Address - Country:US
Mailing Address - Phone:256-682-7048
Mailing Address - Fax:
Practice Address - Street 1:4517 PINE TREE CIR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2307
Practice Address - Country:US
Practice Address - Phone:205-915-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4509C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical