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General NPI Number Information
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NPI Number | 1790991990
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Entity Type | Individual
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Provider Name | SHIRLEY ANN MACK PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15501 METROPOLITAN PKWY SUITE 107
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1684
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Country | US
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Telephone | 586-263-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 20466 FLEETWOOD DR
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City | HARPER WOODS
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State | MI
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Zip | 48225-1624
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Country | US
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Telephone | 313-522-1569
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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 | 6401005017
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License Number State | MI
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