Most Relevant Information
Provider Data
| NPI Number: | 1003576364 |
| Provider Name: | MALLORY OLIVIA BONAR |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 005929 |
Most Important Dates
| Enumeration Date: | 12/28/2021 |
| Last Updated: | 12/28/2021 |
Provider Practice Location
28407 STATE ROUTE 7
MARIETTA
OH
457505152
Practice Location Phone/Fax
| Phone: | 7403715476 |
| Fax: |
Provider Mailing Location
28407 STATE ROUTE 7
MARIETTA
OH
457505152
Provider Mailing Phone/Fax
| Phone: | 7403715476 |
| Fax: |