Provider Demographics
NPI:1992967426
Name:MACIE, KATHERINE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:MACIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MACIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, PLLC
Mailing Address - Street 1:3323 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2905
Mailing Address - Country:US
Mailing Address - Phone:804-314-7735
Mailing Address - Fax:
Practice Address - Street 1:17 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2109
Practice Address - Country:US
Practice Address - Phone:804-728-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical