Provider Demographics
NPI:1134724263
Name:D. MACK CONSULTING LLC
Entity type:Organization
Organization Name:D. MACK CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIOR TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRIEN
Authorized Official - Middle Name:DENARD
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:RBT-20-117604
Authorized Official - Phone:850-774-5832
Mailing Address - Street 1:1614 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3148
Mailing Address - Country:US
Mailing Address - Phone:850-774-5832
Mailing Address - Fax:
Practice Address - Street 1:1614 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3148
Practice Address - Country:US
Practice Address - Phone:850-774-5832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health