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Individual
MALLORY LOGAN FREDERICK
Active
Individual
MALLORY LOGAN FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S, C.D.C.A.
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
150835
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
04/12/2016
Last updated
03/29/2017
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