Individual
ANGELL Y MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
620 N WALNUT ST, SPRINGFIELD, IL 62702-4930
(217) 544-4631
Mailing address
620 N WALNUT ST, SPRINGFIELD, IL 62702-4930
(217) 544-4631
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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