Individual
MS. MALLORY WARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, CAC
Contact information
Practice address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3713
Mailing address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3713
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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