Individual
MALLORY L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
241 DARDEN DR, POQUOSON, VA 23662-1215
(757) 356-2242
(276) 242-5657
Mailing address
22 BELLES COVE DR APT F, POQUOSON, VA 23662-1558
(757) 818-0426
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-427589
VA
Other
Enumeration date
04/18/2025
Last updated
04/18/2025
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