Provider Demographics
NPI:1073971545
Name:MACK, ORLANDO WADE (BACHELORS)
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:WADE
Last Name:MACK
Suffix:
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2452
Mailing Address - Country:US
Mailing Address - Phone:318-871-5566
Mailing Address - Fax:318-871-1076
Practice Address - Street 1:809 POLK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2452
Practice Address - Country:US
Practice Address - Phone:318-871-5566
Practice Address - Fax:318-871-1076
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health