Individual
CONNIE JO MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS, LPC
Contact information
Practice address
133 TIARA DR TRLR 3, KINGS MOUNTAIN, NC 28086-7820
(704) 730-8762
Mailing address
133 TIARA DR TRLR 3, KINGS MOUNTAIN, NC 28086-7820
(704) 730-8762
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6005931
NC
101YM0800X
Mental Health Counselor
Primary
6695
NC
Other
Enumeration date
10/11/2007
Last updated
07/22/2009
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