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Individual
ROBERTA A MACK
Active
Individual
ROBERTA A MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CADCIII LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11611
WI
101YP2500X
Professional Counselor
Primary
3598
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39715500
—
WI
Enumeration date
06/08/2006
Last updated
07/13/2026
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