Healthcare Provider Details

I. General information

NPI: 1154276863
Provider Name (Legal Business Name): MACKENZIE WILLBANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N YORK RD
HATBORO PA
19040-2045
US

IV. Provider business mailing address

345 N YORK RD
HATBORO PA
19040-2045
US

V. Phone/Fax

Practice location:
  • Phone: 215-323-4244
  • Fax:
Mailing address:
  • Phone: 215-323-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002018
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: