Provider Demographics
NPI:1144244518
Name:MACKINNON, CELIA A (LMHC LMFT)
Entity Type:Individual
Prefix:MS
First Name:CELIA
Middle Name:A
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:LMHC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 WESTERN AVE
Mailing Address - Street 2:C/O INNERWELL INTEGRATIVE COUNSELING SERVICES
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6246
Mailing Address - Country:US
Mailing Address - Phone:802-231-2550
Mailing Address - Fax:
Practice Address - Street 1:262 WESTERN AVE
Practice Address - Street 2:C/O INNERWELL INTEGRATIVE COUNSELING SERVICES
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6246
Practice Address - Country:US
Practice Address - Phone:802-231-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC5591101YM0800X
MALMFT 1287106H00000X
VT100.0109835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health