Individual
AUDREY MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3711 EXECUTIVE CENTER DR, SUITE 202 OFFICE #3, MARTINEZ, GA 30907-0951
(706) 394-4357
Mailing address
3490 BULLOCK AVE, AUGUSTA, GA 30906-4615
(706) 394-4357
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC006746
GA
Other
Enumeration date
04/27/2014
Last updated
04/27/2014
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