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DESMOND MACK
NPI 1053058800
Counselor - Professional in Southfield, MI

Active since May 13, 2022
20411 W 12 MILE RD STE 104, SOUTHFIELD, MI 48076(248) 617-7545 Get Directions Write a Review

NPPES record last updated: May 13, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Desmond Mack NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DESMOND MACK (NPI 1053058800) is an individual professional provider in Southfield, Michigan, licensed in (640108797) and active in the NPI registry since May 2022.

NPPES Registry Identity

NPI1053058800
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameDESMOND MACK
Location Address20411 W 12 MILE RD STE 104Southfield, MI 48076-6404
Mailing Address20411 W 12 Mile Rd Ste 104Southfield, MI 48076-6404
Phone(248) 617-7545
Sole ProprietorYes
Enumeration DateMay 13, 2022
NPPES CertifiedMay 13, 2022
✔ NPI 1053058800 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed · 640108797
20411 W 12 MILE RD STE 104, Southfield, MI 48076
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Oscar Insurance Company and more.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Desmond Mack's NPI number?

The NPI number for Desmond Mack is 1053058800. It was assigned to this individual provider in the NPPES registry on May 13, 2022.

Where is Desmond Mack located?

Desmond Mack practices at 20411 W 12 Mile Rd Ste 104, Southfield, MI 48076. The listed phone number is (248) 617-7545.

What is Desmond Mack's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

What insurance does Desmond Mack accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Oscar Insurance Company, Priority Health and UnitedHealthcare list Desmond Mack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Desmond Mack was last updated on May 13, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.