Provider Demographics
NPI:1952776114
Name:MACKENZIE, LISBETH (LCAS-A, CSAPC)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LCAS-A, CSAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 LAWNDALE DR. APT A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455
Mailing Address - Country:US
Mailing Address - Phone:336-908-9729
Mailing Address - Fax:
Practice Address - Street 1:5011 LAWNDALE DR APT A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2157
Practice Address - Country:US
Practice Address - Phone:336-908-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21635101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)