Provider Demographics
NPI:1053747535
Name:KAREN MACKE MA, LPC-S, PLLC
Entity type:Organization
Organization Name:KAREN MACKE MA, LPC-S, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MACKE
Authorized Official - Suffix:I
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:828-400-3772
Mailing Address - Street 1:563 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3817
Mailing Address - Country:US
Mailing Address - Phone:828-400-3772
Mailing Address - Fax:888-522-1120
Practice Address - Street 1:451 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3096
Practice Address - Country:US
Practice Address - Phone:828-400-3772
Practice Address - Fax:888-522-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC-S7429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104770Medicaid