Individual
DR. IVY J MALLISHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
5041 WARM SPRINGS RD, SUITE B, COLUMBUS, GA 31909-6938
(706) 569-9199
(706) 569-8990
Mailing address
5041 WARM SPRINGS RD, SUITE B, COLUMBUS, GA 31909-6938
(706) 569-9199
(706) 569-8990
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001132
GA
Other
Enumeration date
01/16/2006
Last updated
07/09/2007
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