Provider Demographics
NPI:1871063578
Name:ADAMS, MALLORY (LPC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ABERCROMBIE WAY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6895
Mailing Address - Country:US
Mailing Address - Phone:256-503-9990
Mailing Address - Fax:
Practice Address - Street 1:221 RUE DE JEAN STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8501
Practice Address - Country:US
Practice Address - Phone:337-484-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4552101Y00000X
WYLPC1946101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor