Organization
MOMMAS VILLAGE FAYETTEVILLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA TATUM MALLOY IBCLC, CD (PRESIDENT/CEO/LACTATION DIRECTOR)
(910) 764-8314
Entity
Organization
Contact information
Practice address
131 HAY ST STE 201, FAYETTEVILLE, NC 28301-6105
(910) 764-8314
Mailing address
PO BOX 53224, FAYETTEVILLE, NC 28305-3224
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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