| Mackenzie Counseling And Consultation Services | |
|
11315 Pembrooke Sq Ste 112a Waldorf MD 20603-4806 | |
| (850) 377-5389 | |
| Not Available |
| Full Name | Mackenzie Counseling And Consultation Services |
|---|---|
| Speciality | Psychologist |
| Location | 11315 Pembrooke Sq Ste 112a, Waldorf, Maryland |
| Authorized Official Name and Position | Lavonne A Browne (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 8503775389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mackenzie Counseling And Consultation Services Po Box 249 Olney MD 20830-0249 Ph: (850) 377-5389 | Mackenzie Counseling And Consultation Services 11315 Pembrooke Sq Ste 112a Waldorf MD 20603-4806 Ph: (850) 377-5389 |
| NPI Number | 1285953380 |
|---|---|
| Provider Enumeration Date | 05/28/2010 |
| Last Update Date | 02/15/2023 |
| Certification Date | 02/15/2023 |
| Medicare PECOS PAC ID | 5294009973 |
|---|---|
| Medicare Enrollment ID | O20230313002115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285953380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lavonne Antoinette Browne |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598933764 PECOS PAC ID: 6103190889 Enrollment ID: I20230314000366 |
| Provider Name | Linda Yaya Kalle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538420807 PECOS PAC ID: 7315302817 Enrollment ID: I20230506000067 |
| Provider Name | Kimberly Patrice Brown-gross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124781356 PECOS PAC ID: 7012372451 Enrollment ID: I20230508001636 |
| Provider Name | Bernadette Veshegho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043918428 PECOS PAC ID: 4284081308 Enrollment ID: I20231113000030 |
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