Provider Demographics
NPI:1508231945
Name:KUBINA, MACKENSEY (LGSW)
Entity Type:Individual
Prefix:
First Name:MACKENSEY
Middle Name:
Last Name:KUBINA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30537 POTOMAC WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3179
Mailing Address - Country:US
Mailing Address - Phone:240-718-4823
Mailing Address - Fax:301-884-2525
Practice Address - Street 1:30537 POTOMAC WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3179
Practice Address - Country:US
Practice Address - Phone:240-718-4823
Practice Address - Fax:301-884-2525
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker