Individual
LARISSA ILLYN MACKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., APC, NCC
Contact information
Practice address
622 PONDER PLACE DR STE 2, EVANS, GA 30809-3119
(706) 471-0603
Mailing address
622 PONDER PLACE DR STE 2, EVANS, GA 30809-3119
(706) 471-0603
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
APC010419
GA
Other
Enumeration date
06/30/2025
Last updated
06/30/2025
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