Individual
MRS. MALLORY C SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
4485 WESTMINSTER PL, SAINT LOUIS, MO 63108-1812
(314) 535-7911
Mailing address
5609 DEVONSHIRE AVE, SAINT LOUIS, MO 63109-2872
(314) 494-1714
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2012007447
MO
Other
Enumeration date
04/30/2012
Last updated
06/01/2016
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