Individual
MRS. KIMBERLY M MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSC
Contact information
Practice address
300 13TH AVE W STE 1, DICKINSON, ND 58601-4875
(701) 227-7500
(701) 227-7575
Mailing address
300 13TH AVE W STE 1, DICKINSON, ND 58601-4875
(701) 227-7500
(701) 227-7575
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
702-11-15-11
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54523
—
ND
Enumeration date
07/19/2011
Last updated
04/07/2014
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