Provider Demographics
NPI:1568279925
Name:MCKENZIE, DINISHA NECHELLE (CADCII)
Entity type:Individual
Prefix:
First Name:DINISHA
Middle Name:NECHELLE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 HAWKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5848
Mailing Address - Country:US
Mailing Address - Phone:478-788-0066
Mailing Address - Fax:
Practice Address - Street 1:6132 HAWKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5848
Practice Address - Country:US
Practice Address - Phone:478-788-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)