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1730773490
TARA NICOLE MACKIE
FONTANA, CA
NPI
1730773490
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: CA 99719)
Enumeration Date
2021-02-23
Last Update Date
2021-02-23
Business Address
TARA NICOLE MACKIE LCSW
17284 SLOVER AVE # 105
FONTANA, CA 92337-7584
Phone number: 909-609-3848
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Mailing Address
TARA NICOLE MACKIE LCSW
792 VISTA REAL ST
CORONA, CA 92879-7701
Phone number: 909-229-3640
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