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Individual

MARY STACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
6624 JIMMY CARTER BLVD STE A, PEACHTREE CORNERS, GA 30071-1727
(770) 743-0004
(404) 900-5453
Mailing address
3497 TULIP TREE LN, DULUTH, GA 30096-5332
(678) 234-3685

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004583

Other

Enumeration date
05/15/2017
Last updated
05/15/2017
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