Organization
BLACKBIRD AND CORNERSTONE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARLY MELISSA MOCK LPC, MS (LICENSED PROFESSIONAL COUNSELOR)
(912) 618-9568
Entity
Organization
Contact information
Practice address
326 MYRTLE CROSSING DR, STATESBORO, GA 30458-4688
(912) 489-7590
Mailing address
175 PAT MOCK ROAD, STATESBORO, GA 30458-6483
(912) 618-9568
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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