MEDICARE: HEATHER MACINSKI LCDC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	162225	OH

General Provider Information

NPI Number	:	1801537477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MACINSKI LCDC II

Provider Business Mailing Address
First Line	:	7058 CORPORATE WAY STE 3
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4243
Country	:	US
Telephone Number	:	937-991-0080
Fax Number	:	937-991-0083

Provider Business Practice Location Address
First Line	:	7058 CORPORATE WAY STE 3
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4243
Country	:	US
Telephone Number	:	937-991-0080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	06/03/2026

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