Individual
CORESAIR ANTON MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 E HILLCREST DR APT 4210, DEKALB, IL 60115-2452
(847) 421-4613
Mailing address
220 E HILLCREST DR APT 4210, DEKALB, IL 60115-2452
(847) 421-4613
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
180012529
IL
Other
Enumeration date
09/06/2016
Last updated
05/06/2021
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