Provider Demographics
NPI:1346950144
Name:MACKEY, THERESA ANN (LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:207 S WESTGATE DR STE G-J
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1675
Mailing Address - Country:US
Mailing Address - Phone:336-273-9611
Mailing Address - Fax:336-273-9663
Practice Address - Street 1:207 S WESTGATE DR STE G-J
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1675
Practice Address - Country:US
Practice Address - Phone:336-273-9611
Practice Address - Fax:336-273-9663
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28545101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)