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General NPI Number Information
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NPI Number | 1114104478
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Entity Type | Individual
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Provider Name | CECELIA MARIE MACK LPC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 265 BOULEVARD NE
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City | ATLANTA
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State | GA
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Zip | 30312-1208
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Country | US
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Telephone | 404-730-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 GEORGE BUSBEE PKWY NW APT 1420
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City | KENNESAW
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State | GA
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Zip | 30144-6642
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Country | US
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Telephone | 470-259-6575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC004994
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004994
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License Number State | GA
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