| Doctor Name: | MALLORY R WINES |
| NPI Number: | 1154731354 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | C.0900646 |
| Business Practice Address: | 7880 Lincole Pl Lisbon, OH - 444328322 |
| Business Phone Number: | 3304247221 |
| Business Fax Number: | 3304243731 |
| Mailing Address: | 2460 Stagecoach Rd, EAST LIVERPOOL |
| State: | OH |
| Postal Code: | 439209506 |
| Phone Number: | 3307089683 |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2014 |
| NPI Last Update Date: | 10/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C.0900646 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |