Provider Demographics
NPI:1124824461
Name:MALLORY, GABRIELLA ALEXZANDRIA
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:ALEXZANDRIA
Last Name:MALLORY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19206 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1693
Mailing Address - Country:US
Mailing Address - Phone:313-675-3426
Mailing Address - Fax:
Practice Address - Street 1:2470 COLLINGWOOD ST STE 217
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1500
Practice Address - Country:US
Practice Address - Phone:248-884-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker