Provider Demographics
NPI:1154731354
Name:WINES, MALLORY R (LPC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:R
Last Name:WINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:R
Other - Last Name:SCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPCC
Mailing Address - Street 1:16856 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9443
Mailing Address - Country:US
Mailing Address - Phone:330-708-9683
Mailing Address - Fax:
Practice Address - Street 1:7880 LINCOLE PL
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8322
Practice Address - Country:US
Practice Address - Phone:330-424-7221
Practice Address - Fax:330-424-3731
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health