Mallery, Jack Eugene
Mallery, Jack Eugene is an individual health care provider with primary practice located at 7305 Hampton Blvd , Norfolk VA 23505-2908. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Marriage & Family Therapist is his primary health care specialty. Mallery, Jack Eugene can be contacted via phone (757) 623-2700.Contact Information
Primary practice address
7305 Hampton Blvd
Norfolk VA 23505-2908
Phone: (757) 623-2700
Fax: (757) 640-1058
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 0718000021 | Virginia |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 0701002423 | Virginia |
| Other Service Providers / Peer Specialist | 175T00000X | ||
| Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | 0717000586 | Virginia |
Profile Details
| NPI number | 1700969383 |
|---|---|
| LBN Legal business name | Mallery, Jack Eugene |
| Credentials | Licensed Professional Counselor (LPC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 24th, 2006 |
| Last updated | Dec 12th, 2022 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700969383 | NPPES |
| Virginia | Other | 004945395 | PROVIDER NUMBER |
| Virginia | Other | 175080 | PROVIDER NUMBER |
| Virginia | MEDICAID | 004945395 | PROVIDER NUMBER |
| Virginia | Other | 083239M | PROVIDER NUMBER |
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