Provider Demographics
NPI:1760184865
Name:MACKEY, LATISHA ANTOINETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:ANTOINETTE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 CROSSROADS STATION BLVD APT 308
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1752
Mailing Address - Country:US
Mailing Address - Phone:703-862-7342
Mailing Address - Fax:
Practice Address - Street 1:1386 LAMBERTON DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3414
Practice Address - Country:US
Practice Address - Phone:929-290-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst