Individual
NICOLE M MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
618 W ACADEMY ST, CANTON, MS 39046-4225
(769) 251-3329
Mailing address
618 W ACADEMY ST, CANTON, MS 39046-4225
(769) 251-3329
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
04/20/2015
Last updated
02/09/2016
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