Provider Demographics
NPI:1194594481
Name:DRALLE, MACKENZIE JAMES (LCSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JAMES
Last Name:DRALLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 GOLF COURSE RD APT 8
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8814
Mailing Address - Country:US
Mailing Address - Phone:847-732-0922
Mailing Address - Fax:
Practice Address - Street 1:971 GOLF COURSE RD APT 8
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8814
Practice Address - Country:US
Practice Address - Phone:847-732-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0254331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical