Individual
NIKOLE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COUNSELOR TRAINEE CT
Contact information
Practice address
3951 ROCKY RIVER DR, CLEVELAND, OH 44111-4154
(216) 332-9360
Mailing address
5445 SMITH RD, BROOKPARK, OH 44142-2026
(216) 332-9360
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C.2304902-TRNE
OH
106S00000X
Behavior Technician
APP000695832
OH
175T00000X
Peer Specialist
APP000695832
OH
Other
Enumeration date
05/25/2023
Last updated
04/19/2024
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