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Individual

GERALDINE MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 425-2252
(318) 227-3357
Mailing address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 425-2252
(318) 227-3357

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3681
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3681
LIC CLINICAL SOCIAL WORKE
LA
01
MFT 852
LICENSED MARRIAGE AND FAM
LA
Enumeration date
07/02/2007
Last updated
07/08/2007
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