Active NPI
Mallory McKnight Dill
- Professional Counselor
- Cleveland, MS
National Provider Identifier
1376128603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0536
- Practice address
- 212 N Chrisman Ave
Cleveland, MS 38732-2730 - Phone
- (662) 719-2505
- NPI assigned
- Mar 17, 2021
- Last updated
- Mar 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0536 | MS | Primary |
Addresses
Primary practice location
212 N Chrisman Ave
Cleveland, MS 38732-2730
Mailing address
56 Horseshoe Dr
Merigold, MS 38759-9658
Phone (662) 719-8757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0536 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615939200000",
"number": "1376128603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 HORSESHOE DR",
"city": "MERIGOLD",
"state": "MS",
"postal_code": "387599658",
"telephone_number": "662-719-8757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 N CHRISMAN AVE",
"city": "CLEVELAND",
"state": "MS",
"postal_code": "387322730",
"telephone_number": "662-719-2505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILL",
"first_name": "MALLORY",
"middle_name": "MCKNIGHT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-17",
"last_updated": "2021-03-17",
"certification_date": "2021-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "MS",
"license": "0536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, MS
- Delta Soul Medical, LLC
- Delta State University
- Delta Vein and Artery Center, P. C.
- Delta Wound Care PLLC
- Delta Wound Care Services Inc.
- Anna Marie Dobbins, PHARMD
- Wayne Anthony Dotson, MD
- Dynamic Cleveland Operating Company LLC (Bolivar Health and Rehabiliation Center)
- Lutoya Earvin, DPC, LPC, NCC, NCSC
- De'Andrea Latrice Eason
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.