Kaneisha Mack, CPS-WH

NPI #1952862286 in Lagrange, Georgia

Provider Information

NPI Number: 1952862286
Entity Type: Individual
Name: Kaneisha Mack, CPS-WH
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Credential: CPS-WH
Enumeration Date: Mar 28, 2019
Last Updated: Mar 28, 2019

Practice Location

Address: 122 GORDON COMMERCIAL DR
City: Lagrange
State: Georgia
ZIP Code: 30240-5754
Phone: (706) 845-4054

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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