Provider Demographics
NPI:1447570577
Name:MACK, GEORGIANNA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-6324
Mailing Address - Country:US
Mailing Address - Phone:910-843-7366
Mailing Address - Fax:
Practice Address - Street 1:1244 MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-6324
Practice Address - Country:US
Practice Address - Phone:910-843-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0066911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical