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Individual
MS. SANDRA M MACK
Active
Individual
MS. SANDRA M MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,CSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW013656
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2172359000
PERSONAL CHOICE2
PA
Enumeration date
11/08/2006
Last updated
07/08/2007
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