Provider Demographics
NPI:1861890246
Name:MALLARD, TAMIKA I (SOCIAL WORKER, BS)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:MALLARD
Suffix:I
Gender:F
Credentials:SOCIAL WORKER, BS
Other - Prefix:
Other - First Name:TAMIKA
Other - Middle Name:
Other - Last Name:MALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3009 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7611
Mailing Address - Country:US
Mailing Address - Phone:754-201-9855
Mailing Address - Fax:
Practice Address - Street 1:800 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-0916
Practice Address - Country:US
Practice Address - Phone:754-701-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor