Most Relevant Information
Provider Data
| NPI Number: | 1003301748 |
| Provider Name: | TIARA MALLORY RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-16-24889 |
Most Important Dates
| Enumeration Date: | 06/26/2018 |
| Last Updated: | 06/26/2018 |
Provider Practice Location
3105 AMERICAN LEGION RD
CHESAPEAKE
VA
233215654
Practice Location Phone/Fax
| Phone: | 7572169541 |
| Fax: |
Provider Mailing Location
112 SUITE LIFE CIR STE L
NEWPORT NEWS
VA
236062987
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |