Mack, Desra

Mack, Desra is an individual health care provider with primary practice located at 1141 N Road St Suite L, Elizabeth City NC 27909-3354. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Mack, Desra can be contacted via phone (252) 335-0803.

Contact Information

Primary practice address
1141 N Road St Suite L Elizabeth City NC 27909-3354
Phone: (252) 335-0803
Fax: (252) 331-1796
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 5415 North Carolina

Profile Details

NPI number 1588761530
LBN Legal business name Mack, Desra
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Mar 1st, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588761530 NPPES
North Carolina MEDICAID 6103306

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