Individual
CAROL MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
(662) 741-2151
(662) 741-2700
Mailing address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
(662) 741-2151
(662) 741-2700
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C1799
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118622
—
MS
Enumeration date
01/11/2008
Last updated
01/11/2008
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