Individual
MISS LATAVIA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 OAK ST, BOWMAN, SC 29018
(803) 596-8651
Mailing address
PO BOX 485, BOWMAN, SC 29018-0485
(803) 596-8651
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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