Individual
MALLORY MAGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
60 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 695-1240
(479) 695-1242
Mailing address
4041 N BROOKHOLLOW CT, FAYETTEVILLE, AR 72703-5064
(479) 571-0334
(479) 750-8967
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/24/2014
Last updated
06/24/2014
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