Provider Demographics
NPI:1689644486
Name:MACKIN, CARLEEN MARIE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:MARIE
Last Name:MACKIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 DUBSDREAD CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3053
Mailing Address - Country:US
Mailing Address - Phone:407-399-3766
Mailing Address - Fax:407-423-1958
Practice Address - Street 1:934 N. MAGNOLIA AVE. SUITE 119
Practice Address - Street 2:SUITE 119
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-399-3766
Practice Address - Fax:407-423-1958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health