Provider Demographics
NPI:1427225804
Name:MACKIE, JUAQUINA
Entity Type:Individual
Prefix:
First Name:JUAQUINA
Middle Name:
Last Name:MACKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4834
Mailing Address - Country:US
Mailing Address - Phone:323-753-5950
Mailing Address - Fax:323-753-6020
Practice Address - Street 1:8904 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4834
Practice Address - Country:US
Practice Address - Phone:323-753-5950
Practice Address - Fax:323-753-6020
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)