Mallisham, Ivy J
Mallisham, Ivy J is an sole proprietor health care provider with primary practice located at 5041 Warm Springs Rd Suite B, Columbus GA 31909-6938. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Mallisham, Ivy J can be contacted via phone (706) 569-9199.Contact Information
Primary practice address
5041 Warm Springs Rd Suite B
Columbus GA 31909-6938
Phone: (706) 569-9199
Fax: (706) 569-8990
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY001132 | Georgia |
Profile Details
| NPI number | 1689653743 |
|---|---|
| LBN Legal business name | Mallisham, Ivy J |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 16th, 2006 |
| Last updated | Jul 9th, 2007 - about 19 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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