Provider Demographics
NPI:1134800956
Name:MACKIE, PAMELA (MFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MACKIE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1906
Mailing Address - Country:US
Mailing Address - Phone:917-846-3694
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 908
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7641
Practice Address - Country:US
Practice Address - Phone:404-666-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist