Individual
DONTE JOHNATHAN MALLOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
734 10TH AVE, SAN DIEGO, CA 92101-6502
(619) 239-4663
Mailing address
734 10TH AVE, SAN DIEGO, CA 92101-6502
(619) 239-4663
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
CA
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
02/25/2019
Last updated
09/04/2025
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