Provider Demographics
NPI:1699389601
Name:MACK, GEORGE III (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MACK
Suffix:III
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 ARROW DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5825
Mailing Address - Country:US
Mailing Address - Phone:423-258-2161
Mailing Address - Fax:
Practice Address - Street 1:1925 W ANDREW JOHNSON HWY UNIT 1
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3757
Practice Address - Country:US
Practice Address - Phone:423-258-2161
Practice Address - Fax:423-225-8432
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health