Provider Demographics
NPI:1275148900
Name:MACKIN, MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MACKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 MESSICK ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1016
Mailing Address - Country:US
Mailing Address - Phone:850-549-5130
Mailing Address - Fax:
Practice Address - Street 1:8631 MESSICK ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1016
Practice Address - Country:US
Practice Address - Phone:850-549-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW169681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical