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Individual
JASON ALLEN MACK
Active
Individual
JASON ALLEN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSWI
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5593
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/13/2019
Last updated
10/09/2019
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