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:
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Health care specialties

SpecialtyCodeLicense #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 3 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 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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