Individual
MRS. BRENDA W. MALLERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2940 N LYNNHAVEN RD, SUITE 110, VIRGINIA BEACH, VA 23452-6949
(757) 450-7587
Mailing address
2114 BAYBERRY ST, VIRGINIA BEACH, VA 23451-1402
(757) 450-7587
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904001113
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861562472
—
VA
Enumeration date
10/26/2006
Last updated
02/25/2014
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