| Doctor Name: | DR. CAROL MACK |
| NPI Number: | 1063714566 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PC003007 |
| Business Practice Address: | 454 N. Claude A. Lord Blvd. Pottsville, PA - 179012706 |
| Business Phone Number: | 5706221025 |
| Business Fax Number: | 5706284344 |
| Mailing Address: | 454 N. Claude A. Lord Blvd., POTTSVILLE |
| State: | PA |
| Postal Code: | 179012706 |
| Phone Number: | 5706221025 |
| Fax Number: | 5706284344 |
| NPI Enumeration Date: | 12/03/2010 |
| NPI Last Update Date: | 12/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC003007 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |