Organization
MOLDING PASSIONATE ACTIVE CREATIVE KIDS CORPORATION
Active
Organization
MOLDING PASSIONATE ACTIVE CREATIVE KIDS CORPORATION
Active
Other names
M-PACK
Organization subpart
No
Provider details
NPI number
Authorized official
DEMARCUS DEVON COPELANND C.L.C (FOUNDER AND PROGRAM DIRECTOR)
(678) 849-4656
Entity
Organization
Contact information
Practice address
302 N PARK ST, CARROLLTON, GA 30117-3056
(678) 849-4656
Mailing address
302 N PARK ST, CARROLLTON, GA 30117-3056
(678) 849-4656
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/05/2024
Last updated
11/06/2025
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