Provider Demographics
NPI:1801351119
Name:MACK-JONES, DORISENICA (CERTIFICATION)
Entity type:Individual
Prefix:
First Name:DORISENICA
Middle Name:
Last Name:MACK-JONES
Suffix:
Gender:F
Credentials:CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CARVER MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-4926
Mailing Address - Country:US
Mailing Address - Phone:864-401-7747
Mailing Address - Fax:
Practice Address - Street 1:502 CARVER MILL RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-4926
Practice Address - Country:US
Practice Address - Phone:864-401-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management