Provider Demographics
NPI:1326437187
Name:MACKENZIE, JANET MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MICHELLE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GRAFTON LN
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-2576
Mailing Address - Country:US
Mailing Address - Phone:540-955-2400
Mailing Address - Fax:540-955-2019
Practice Address - Street 1:180 GRAFTON LN
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-2576
Practice Address - Country:US
Practice Address - Phone:540-955-2400
Practice Address - Fax:540-955-2019
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical