Individual
SHANITA MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
900 COMMONWEALTH PL STE 225, VIRGINIA BEACH, VA 23464-4517
(757) 895-7007
Mailing address
10 BIG BETHEL RD APT A, HAMPTON, VA 23666-4736
(757) 589-8720
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704007981
VA
Other
Enumeration date
02/11/2020
Last updated
03/30/2023
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