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1033385711
LATASHA MACK
STOCKTON, CA
NPI
1033385711
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2008-05-02
Last Update Date
2008-05-02
Business Address
-- LATASHA MACK
8026 LORRAINE AVE STE 201
STOCKTON, CA 95210-4224
Phone number: 209-644-6328
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Mailing Address
-- LATASHA MACK
8026 LORRAINE AVE STE 201
STOCKTON, CA 95210-4224
Phone number: 209-644-6328
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