Individual
OLIVIA J MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1195 BROOKSTONE WAY, AUGUSTA, GA 30909-5656
(912) 755-1554
Mailing address
1195 BROOKSTONE WAY, AUGUSTA, GA 30909-5656
(912) 755-1554
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
12367556
GA
Other
Enumeration date
02/21/2024
Last updated
02/21/2024
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