Individual
JACQUELINE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.H.P, M.A.
Contact information
Practice address
215 COMMERCE ST, MANNING, SC 29102-2638
(803) 435-2124
Mailing address
215 N MAGNOLIA ST, SUMTER, SC 29150-4943
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376241
—
SC
Enumeration date
03/28/2007
Last updated
08/21/2007
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