John William Mack, BA, CDP

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CG60142038 Issued in WA

Practice address

17018 15TH Ave NE
Shoreline, WA 98155-5137

Phone

(206) 601-9804

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787097600000",
    "number": "1952463234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17018 15TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981555137",
            "telephone_number": "206-601-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17018 15TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981555137",
            "telephone_number": "206-601-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "credential": "BA, CDP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP 00002940",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG60142038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Ann Lyons, L.M.F.T., CMHS
• Grace Fuk Wai Ma
• Qianlu Ma
• Stephen Michael Macgeorge, DDS
• Gregory Atticus Mack, D.C.
• Paul A Mack, DC
• Laura Sheree Brunt Macleod, PHD
• Joy Mactavish-Unten, IBCLC, ICCE, CD, PCD
• Meghan Magone, MA
• Justin Charles Maher

• Counselor in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.