Provider Demographics
NPI:1407360498
Name:RICHARDS, MACKENZIE M (CDCA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 BELL ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2805
Mailing Address - Country:US
Mailing Address - Phone:419-206-9144
Mailing Address - Fax:
Practice Address - Street 1:2600 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1711
Practice Address - Country:US
Practice Address - Phone:513-751-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.162293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)