Provider Demographics
NPI:1619121514
Name:M.A. C. UNLIMITED, LLC
Entity Type:Organization
Organization Name:M.A. C. UNLIMITED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-766-7198
Mailing Address - Street 1:5017 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-1623
Mailing Address - Country:US
Mailing Address - Phone:314-766-7198
Mailing Address - Fax:
Practice Address - Street 1:5017 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1623
Practice Address - Country:US
Practice Address - Phone:314-766-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty