Individual
MRS. DESRA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1141 N ROAD ST, SUITE L, ELIZABETH CITY, NC 27909-3354
(252) 335-0803
(252) 331-1796
Mailing address
4300 SAPPHIRE CT STE 110, GREENVILLE, NC 27834-9079
(252) 830-7540
(252) 413-0932
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5415
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103306
—
NC
Enumeration date
09/20/2006
Last updated
03/01/2011
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