Individual
ANITA JEAN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4954 E 56TH ST, INDIANAPOLIS, IN 46220-5773
(317) 500-4266
Mailing address
12595 WINDY POINTE LOOP APT 108, ORLANDO, FL 32824-5365
(317) 827-4725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/06/2021
Last updated
10/20/2022
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