Provider Demographics
NPI:1316053010
Name:MACKE, MERRY H (LCSW, CP)
Entity type:Individual
Prefix:MS
First Name:MERRY
Middle Name:H
Last Name:MACKE
Suffix:
Gender:F
Credentials:LCSW, CP
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:H
Other - Last Name:MACKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CP
Mailing Address - Street 1:7522 HAVELOCK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3919
Mailing Address - Country:US
Mailing Address - Phone:703-451-3248
Mailing Address - Fax:
Practice Address - Street 1:8119 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3135
Practice Address - Country:US
Practice Address - Phone:703-799-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040010881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical