Provider Demographics
NPI:1467020784
Name:MACKIE, LAUREN (LMSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MACKIE
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 1:9004 CHERBOURG DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3105
Mailing Address - Country:US
Mailing Address - Phone:301-801-2831
Mailing Address - Fax:
Practice Address - Street 1:8030 WOODMONT AVE APT F3
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3027
Practice Address - Country:US
Practice Address - Phone:301-742-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health