Healthcare Provider Details

I. General information

NPI: 1598994212
Provider Name (Legal Business Name): MAC MARCANTEL HAFELE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 THOMPSON BRIDGE RD
GAINESVILLE GA
30506-1522
US

IV. Provider business mailing address

4235 LAWTON DR
GAINESVILLE GA
30506-4664
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-0977
  • Fax: 770-536-0976
Mailing address:
  • Phone: 770-540-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: