Kelley Elizabeth Mackenzie, MS, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LC3942 Issued in ME

Practice address

650 Main St
Suite 103
South Portland, ME 04106-5448

Phone

(207) 774-4564

Fax

(207) 774-0006

NPI assigned

Feb 13, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Food Addiction Chemical Dependency Consultants LLC

  • Addiction (Substance Use Disorder) Counselor
  • So Portland, ME
  • NPI 1881627958
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297555200000",
    "number": "1740587666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 MAIN ST",
            "address_2": "SUITE 103",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065448",
            "telephone_number": "207-774-4564",
            "fax_number": "207-774-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 MAIN ST",
            "address_2": "SUITE 103",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065448",
            "telephone_number": "207-774-4564",
            "fax_number": "207-774-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "KELLEY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "MS, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-13",
        "last_updated": "2011-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC3942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara B Lyon, PT, DPT
• Killian David Maccarthy, DMD MD
• Patricia B Macdonald, LCPC, RN
• Christina Elizabeth Mack, LMFT
• Danielle Andree Mack, LMSW-CC
• Rachel Theresa Mackie, RN
• Caitlin Macvane, LCSW
• Ella Macveagh, PT
• Lela Black Madfis
• Madison Speech Methods

• Addiction (Substance Use Disorder) Counselor in South Portland, ME
• Providers in South Portland, ME by specialty
• Addiction (Substance Use Disorder) Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.