Individual
DANIEL ROBIN VAN DER MALLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
14574 US HIGHWAY 23, WAVERLY, OH 45690-9373
(740) 912-9126
Mailing address
1725 CHARLES ST, PORTSMOUTH, OH 45662-4639
(740) 947-6727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.162705
OH
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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