Doctor Name: | MALLORY ANN MCDONOUGH |
NPI Number: | 1144569559 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLMSW |
License Number: | 6801093434 |
Business Practice Address: | 26522 Van Dyke Ave Center Line, MI - 480151221 |
Business Phone Number: | 5867594400 |
Business Fax Number: | 5867594401 |
Mailing Address: | 6549 Town Center Dr, Suite A CLARKSTON |
State: | MI |
Postal Code: | 483464824 |
Phone Number: | 2486206400 |
Fax Number: | 2486206405 |
NPI Enumeration Date: | 02/05/2013 |
NPI Last Update Date: | 02/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801093434 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |