Provider Demographics
NPI:1225848864
Name:VISSER-PARDEE, MALLORY CLAIRE (LCSW)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:CLAIRE
Last Name:VISSER-PARDEE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:VISSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1970
Mailing Address - Country:US
Mailing Address - Phone:501-666-8686
Mailing Address - Fax:501-660-6830
Practice Address - Street 1:1521 MERRILL DRIVE
Practice Address - Street 2:SUITE D220
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1654
Practice Address - Country:US
Practice Address - Phone:501-660-6893
Practice Address - Fax:501-954-7798
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9456-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical