Mack, Roberta A
Mack, Roberta A is an individual health care provider with primary practice located at 212 S 11Th Street , Lacrosse WI 54601. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Mack, Roberta A can be contacted via phone (608) 791-9555.Contact Information
Primary practice address
212 S 11Th Street
Lacrosse WI 54601
Phone: (608) 791-9555
Fax: (608) 791-9432
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 11611 | Wisconsin |
Behavioral Health & Social Service Providers / Professional | 101YP2500X | 3598 | Wisconsin |
Profile Details
NPI number | 1558302026 |
---|---|
LBN Legal business name | Mack, Roberta A |
Credentials | MS CADCIII LPC |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 8th, 2006 |
Last updated | Jul 8th, 2007 - about 17 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1558302026 | NPPES |
Wisconsin | MEDICAID | 39715500 |
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