Individual
DIANE MACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NBCC
Contact information
Practice address
1525 12TH ST STE 22, FLORENCE, OR 97439-8487
(541) 902-0408
Mailing address
1525 12TH ST. SUITE 22, FLORENCE, OR 97439
(541) 921-1497
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
35925
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164907
OMAP GROUP
OR
Enumeration date
09/07/2006
Last updated
07/08/2007
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