Evans, Mallory

Evans, Mallory is an individual health care provider with primary practice located at 625 Cleveland Ave Nw , Canton OH 44702-1805. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Evans, Mallory can be contacted via phone (330) 455-0374.

Contact Information

Primary practice address
625 Cleveland Ave Nw Canton OH 44702-1805
Phone: (330) 455-0374
Fax: (330) 455-2101
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CDCA.160336-PRE Ohio
Behavioral Health & Social Service Providers / Mental Health 101YM0800X C1500355 Ohio

Profile Details

NPI number 1114309994
LBN Legal business name Evans, Mallory
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 29th, 2015
Last updated Jul 28th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114309994 NPPES
Ohio MEDICAID 2584314

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