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Individual

MRS. EBONY J MAC

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
401 PINE ST, SAINT LOUIS, MO 63102-2731
(314) 465-5351
Mailing address
6643 CHAMBERLAIN AVE, SAINT LOUIS, MO 63130-2636
(314) 465-5351
(314) 465-5351

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
110950
TX
1041C0700X
Clinical Social Worker
Primary
2009008986
MO

Other

Enumeration date
10/14/2009
Last updated
03/13/2026
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