Individual
ISLAM MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6048 JOHN JACKSON DR, WILLIAMSBURG, VA 23188-7591
(757) 912-3665
Mailing address
6048 JOHN JACKSON DR, WILLIAMSBURG, VA 23188-7591
(757) 912-3665
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0906013183
VA
Other
Enumeration date
03/24/2023
Last updated
03/24/2023
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