Individual
CHARLENE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
47 W DIVISION ST STE 211, CHICAGO, IL 60610-2954
(773) 474-4188
Mailing address
47 W DIVISION ST STE 211, CHICAGO, IL 60610-2954
(773) 474-4188
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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