Individual
DONNALINE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
204 DURDEN ST, VIDALIA, GA 30474-4608
(912) 432-3420
Mailing address
854 CUMMING RD, DUBLIN, GA 31021-1012
(912) 432-3420
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
GA
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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