| NPI | 1578184230 |
|---|---|
| Other Name | CIRQUE MEADOW PSYCHIATRY VIRGINIA CARYL MACK SOLE MBR |
| Entity Type | Organization |
| Authorized Contact | VIRGINIA MACK Owner 360-621-1409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2020-07-29 |