Individual
STACELYNNE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
30601 CREST FRST, FARMINGTON HILLS, MI 48331-1052
(248) 506-4065
Mailing address
PO BOX 47505, OAK PARK, MI 48237-5205
(248) 506-4065
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
6801082564
MI
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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