Provider Demographics
NPI:1790818011
Name:MACK, JAMEE REYNOLDS (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMEE
Middle Name:REYNOLDS
Last Name:MACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMEE
Other - Middle Name:L
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:135 ROSEDOWN CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2960
Mailing Address - Country:US
Mailing Address - Phone:646-584-4993
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD STE 221
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3100
Practice Address - Country:US
Practice Address - Phone:336-331-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073285104100000X
NCC0158561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker