Provider Demographics
NPI:1639663818
Name:MACKIE, ELISSA D (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:D
Last Name:MACKIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 ARMISTEAD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5809
Mailing Address - Country:US
Mailing Address - Phone:901-371-6964
Mailing Address - Fax:
Practice Address - Street 1:5199 HIDEAWAY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9791
Practice Address - Country:US
Practice Address - Phone:901-371-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional