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General NPI Number Information
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NPI Number | 1982289252
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Entity Type | Individual
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Provider Name | MACKENZIE DEFOREST MS, NCC, CRC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 7741 ROSWELL RD STE B
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City | ATLANTA
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State | GA
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Zip | 30350-4845
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Country | US
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Telephone | 404-613-1656
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Fax |
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Provider Business Mailing Address
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Address Line | 11204 JEFFERSON CIR N
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City | CHAMBLEE
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State | GA
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Zip | 30341-2690
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Country | US
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Telephone | 707-122-3957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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