Provider Demographics
NPI:1407598030
Name:MACKENZIE, MOLLY LAWTON (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LAWTON
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SUMMERTIME LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6004
Mailing Address - Country:US
Mailing Address - Phone:518-496-7053
Mailing Address - Fax:
Practice Address - Street 1:2801 SUMMERTIME LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-6004
Practice Address - Country:US
Practice Address - Phone:518-496-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7348101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty