| NPI | 1184450769 |
|---|---|
| Former Name | JENNIFER HEATH MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904017236) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-09-17 |