Individual
MARIE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
8000 MELTON RD, GARY, IN 46403-3114
(219) 938-4651
Mailing address
8000 MELTON RD, GARY, IN 46403-3114
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19412
IL
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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