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Individual
MACKENZIE NICKERSON
Active
Individual
MACKENZIE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, CCS
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CCS7931
ME
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC7602
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CCS7931
CCS
ME
01
—
LC7602
LADC
ME
Enumeration date
05/12/2020
Last updated
06/19/2024
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