Individual
MRS. KATHLEEN SHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., LMFT
Contact information
Practice address
290 CONSTITUTION BLVD, SUITE D, LAWRENCEVILLE, GA 30045-5638
(678) 220-0090
Mailing address
5825 MILLWICK DR, ALPHARETTA, GA 30005-6732
(678) 770-2200
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0000928
GA
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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