Individual
DR. LINDA COOPER LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1371 WADING BIRD LANE, MYRTLE BEACH, SC 29577
(843) 448-6516
Mailing address
PO BOX 70478, MYRTLE BEACH, SC 29572-0026
(843) 602-4284
(843) 448-6516
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1776
SC
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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