Individual
DESMOND MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20411 W 12 MILE RD STE 104, SOUTHFIELD, MI 48076-6404
(248) 617-7545
Mailing address
20411 W 12 MILE RD STE 104, SOUTHFIELD, MI 48076-6404
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
640108797
—
Other
Enumeration date
05/13/2022
Last updated
05/13/2022
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