Individual
CAROL MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1530 N COUNTRY CLUB DR STE 19, MESA, AZ 85201-2560
(520) 582-7418
Mailing address
1530 N COUNTRY CLUB DR STE 19, MESA, AZ 85201-2560
(520) 582-7418
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
102X00000X
Poetry Therapist
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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