NPI 1003301748

Tiara Mallory, RBT

Practitioner Behavior Technician Chesapeake, VA

Practice location

Address: 3105 American Legion Rd, Chesapeake, VA 23321-5654
Phone: (757) 216-9541
Mailing address: 112 Suite Life Cir STE L, Newport News, VA 23606-2987

Registered specialties

Behavior Technician Primary

Behavioral Health & Social Service Providers Taxonomy 106S00000X Licence RBT-16-24889 (VA)

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Registry record

NPI: 1003301748
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Jun 2018
Record last updated: 26 Jun 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.