| Doctor Name: | ROBERTA A MACK |
| NPI Number: | 1558302026 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CADCIII LPC |
| License Number: | 11611 |
| Business Practice Address: | 212 S 11th Street Lacrosse, WI - 54601 |
| Business Phone Number: | 6087919555 |
| Business Fax Number: | 6087919432 |
| Mailing Address: | 700 West Avenue South, Attn Physician Services LACROSSE |
| State: | WI |
| Postal Code: | 54601 |
| Phone Number: | 6087914156 |
| Fax Number: | 6087919898 |
| NPI Enumeration Date: | 06/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11611 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |