Individual
MS. LESLIE RAE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC MS NCC
Contact information
Practice address
510 4TH ST S, FARGO, ND 58103
(701) 476-7200
(701) 476-7273
Mailing address
620 MAIN AVE, 310, FARGO, ND 58103
(701) 371-8411
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5085104
ND
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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