Provider Demographics
NPI:1548392913
Name:MACK, JOSEPH E (CACII)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:MACK
Suffix:
Gender:M
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E SAM HARRELL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-667-6839
Mailing Address - Fax:
Practice Address - Street 1:601 GREGG AVENUE
Practice Address - Street 2:CIRCLE PARK BEHAVIORAL HEALTH SERVICES
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29502-6196
Practice Address - Country:US
Practice Address - Phone:843-665-9349
Practice Address - Fax:843-669-6122
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0601161101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor