Individual
MR. ANTHONY MALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
2699 STIRLING ROAD, SUITE B304, FT. LAUDERDALE, FL 33312
(954) 432-8757
Mailing address
8320 NW 11TH COURT, PEMBROKE PINES, FL 33024
(954) 432-8757
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MH1149
FL
Other
Enumeration date
08/20/2009
Last updated
08/20/2009
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