Individual
MRS. CAROL JO MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8631 DELMAR BLVD, SAINT LOUIS, MO 63124-1990
(314) 787-5100
(314) 754-2800
Mailing address
2800 ELM ST, SAINT CHARLES, MO 63301-4618
(314) 787-5100
(314) 754-2800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2003032210
MO
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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