Individual
KIRA Y MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3595 S TELLER ST, LAKEWOOD, CO 80235-2014
(303) 425-0300
Mailing address
4851 INDEPENDENCE ST, WHEAT RIDGE, CO 80033-6715
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
CSW.09924409
CO
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
04/15/2020
Last updated
07/13/2022
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