Provider Demographics
NPI:1770154296
Name:MACKENZIE, AMBER CANDICE (LCAQ)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:CANDICE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LCAQ
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:CANDICE
Other - Last Name:TUEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1458 JOSEPH CIR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-8101
Mailing Address - Country:US
Mailing Address - Phone:580-747-8283
Mailing Address - Fax:
Practice Address - Street 1:7552 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7305
Practice Address - Country:US
Practice Address - Phone:580-747-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW186881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical