Provider Demographics
NPI:1982289252
Name:DEFOREST, MACKENZIE (MS, NCC, CRC)
Entity Type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:
Last Name:DEFOREST
Suffix:
Gender:F
Credentials:MS, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11204 JEFFERSON CIR N
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2690
Mailing Address - Country:US
Mailing Address - Phone:707-122-3957
Mailing Address - Fax:
Practice Address - Street 1:7741 ROSWELL RD STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4845
Practice Address - Country:US
Practice Address - Phone:404-613-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional