Individual
MS. JACQUELINE MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.S.M., L.S.W.
Contact information
Practice address
24 GLENWOOD AVE, DAYTON, OH 45405-3831
(937) 814-3573
(937) 715-4407
Mailing address
4455 BROADBUSH DR, TROTWOOD, OH 45426-1905
(937) 251-7444
(937) 715-4407
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
.943876
OH
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
S.0014444
OH
Other
Enumeration date
10/19/2006
Last updated
01/01/2024
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