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Mr. Jack Eugene Mallery, LPC
Marriage & Family Therapist in Norfolk, Virginia
NPI 1700969383

Jack Eugene Mallery is a Marriage & Family Therapist based in Virginia Beach, VA. Jack Eugene Mallery practices in Norfolk, VA and has the professional credentials of LPC. The NPI Number for Jack Eugene Mallery is 1700969383 and holds a License No. 0718000021 (Virginia).

The current practice location address for Jack Eugene Mallery is 7305 Hampton Blvd, Norfolk, VA and can be reached out via phone at 757-623-2700 and via fax at 757-640-1058. You can also correspond with Jack Eugene Mallery through the mailing address at 2114 BAYBERRY ST, VIRGINIA BEACH, VA - 23451-1402 (mailing address contact number: 757-481-2485).

Location: 7305 Hampton Blvd, Norfolk, VA, 23451-1402
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1700969383
Provider Name
Jack Eugene Mallery
Credential
LPC
Provider Entity Type
Individual
Gender
Male
Address
7305 Hampton Blvd, Norfolk, VA, 23451-1402
Phone Number
757-623-2700
Fax Number
757-640-1058
Provider Enumeration Date
10/24/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
004945395 01 VA PROVIDER NUMBER
175080 01 VA PROVIDER NUMBER
004945395 05 VA
083239M 01 VA PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
7305 Hampton Blvd
City
Norfolk
State
Virginia
Zip
23505-2908
Phone Number
757-623-2700
Fax Number
757-640-1058
person
Provider Business Mailing Address Details
Address
2114 Bayberry St
City
Virginia Beach
State
Virginia
Zip
23451-1402
Phone Number
757-481-2485
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
0717000586 (Virginia)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Marriage & Family Therapist
Speciality
-
Taxonomy
106H00000X
License No.
0701002423 (Virginia)
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
person
Provider's Taxonomy Details 4
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
0718000021 (Virginia)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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