Individual
DESTINY LACARA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3485 N DESERT DR STE 105, EAST POINT, GA 30344-5724
(678) 724-7033
Mailing address
11009 SOUTHWOOD DR, HAMPTON, GA 30228-3498
(404) 831-2098
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
SLPA000396
GA
235Z00000X
Speech-Language Pathologist
Primary
PCET004155
GA
Other
Enumeration date
07/24/2019
Last updated
02/20/2025
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