Individual
CAMILLE D. MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
4500 W MIDWAY RD, FORT PIERCE, FL 34981-4823
(772) 468-5600
Mailing address
2950 SE OCEAN BLVD APT 129-10, STUART, FL 34996-3570
(772) 834-2021
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH23107
FL
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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