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General NPI Number Information
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NPI Number | 1790818011
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Entity Type | Individual
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Provider Name | JAMEE REYNOLDS MACK LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 8025 N POINT BLVD STE 221
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3100
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Country | US
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Telephone | 336-331-3341
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Fax |
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Provider Business Mailing Address
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Address Line | 135 ROSEDOWN CT
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City | WINSTON SALEM
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State | NC
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Zip | 27106-2960
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Country | US
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Telephone | 646-584-4993
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 073285
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C015856
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License Number State | NC
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