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Individual

ELIZABETH MACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7929 EATON AVE, JACKSONVILLE, FL 32211-7848
(904) 420-2304
Mailing address
7929 EATON AVE, JACKSONVILLE, FL 32211-7848
(907) 725-4410

Taxonomy

Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
17113
FL
Enumeration date
11/06/2019
Last updated
11/06/2019
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