| NPI | 1023510914 |
|---|---|
| Former Name | EBONNY MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007445) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2018-03-06 |