Individual
MALLORY HASENAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA. 173136
Contact information
Practice address
323 MARION PIKE STE 3, COAL GROVE, OH 45638-2958
(740) 646-6640
(866) 475-7263
Mailing address
323 MARION PIKE STE 3, COAL GROVE, OH 45638-2958
(304) 544-8103
(866) 475-7263
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.173136
OH
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
APS.003696
OH
Other
Enumeration date
11/05/2019
Last updated
05/21/2024
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