Provider Demographics
NPI:1609341049
Name:MACKIE, SHAWNA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYNN
Last Name:MACKIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:LYNN
Other - Last Name:POLITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PSC 10 BOX 583
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09142-0006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 442
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:66849
Practice Address - Country:US
Practice Address - Phone:314-542-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C011551104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker