Individual
MACKENZIE C. PASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2651 DALLAS HWY SW, MARIETTA, GA 30064-2541
(678) 486-1904
Mailing address
128 JASMINE PKWY # 128, ALPHARETTA, GA 30022-1684
(404) 536-5441
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
12041895
CO
103K00000X
Behavior Analyst
Primary
12041895
GA
Other
Enumeration date
03/16/2020
Last updated
02/04/2021
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