Provider Demographics
NPI:1568074409
Name:MACKEY, TANDY E (MFT, ST)
Entity Type:Individual
Prefix:
First Name:TANDY
Middle Name:E
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MFT, ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 ESPLANADE CIR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-4220
Mailing Address - Country:US
Mailing Address - Phone:404-840-9204
Mailing Address - Fax:
Practice Address - Street 1:2636 MLK JR DR SW STE 22
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1635
Practice Address - Country:US
Practice Address - Phone:678-705-3828
Practice Address - Fax:404-393-9474
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist