Provider Demographics
NPI:1841048337
Name:EASTON, MACKENZIE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:EASTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5072 JAMES MADISON HWY
Mailing Address - Street 2:
Mailing Address - City:FORK UNION
Mailing Address - State:VA
Mailing Address - Zip Code:23055-2000
Mailing Address - Country:US
Mailing Address - Phone:434-531-1861
Mailing Address - Fax:
Practice Address - Street 1:5072 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:FORK UNION
Practice Address - State:VA
Practice Address - Zip Code:23055-2000
Practice Address - Country:US
Practice Address - Phone:434-531-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician