Provider Demographics
NPI:1376327056
Name:PRICE, MACKENNA (LMSW)
Entity Type:Individual
Prefix:
First Name:MACKENNA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22213 PLOVER ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-3507
Mailing Address - Country:US
Mailing Address - Phone:240-205-5804
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY STE 510
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2819
Practice Address - Country:US
Practice Address - Phone:301-374-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD301951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical