Individual
PORTIA MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
807 PINE SPRINGS RD, COLUMBIA, SC 29210-6333
(803) 369-9848
Mailing address
807 PINE SPRINGS RD, COLUMBIA, SC 29210-6333
(803) 369-9848
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
SC
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
05/27/2019
Last updated
02/17/2021
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