Provider Demographics
NPI:1124065149
Name:MALLORY, KEVIN SCOTT (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:MALLORY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26581
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1581
Mailing Address - Country:US
Mailing Address - Phone:864-787-1283
Mailing Address - Fax:864-268-6020
Practice Address - Street 1:1326 HAYWOOD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2255
Practice Address - Country:US
Practice Address - Phone:864-787-1283
Practice Address - Fax:864-268-6020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional