Provider Demographics
NPI:1518692813
Name:CRAIG, MACKENZIE ANNE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANNE
Last Name:CRAIG
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 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:
Practice Address - Street 1:5831 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:SAINT LEONARD
Practice Address - State:MD
Practice Address - Zip Code:20685-2722
Practice Address - Country:US
Practice Address - Phone:301-852-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician