Provider Demographics
NPI:1235961707
Name:BROOKS, MACKENZIE ROSS (LMFT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ROSS
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ROSS
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:7800 LOVEGRASS TER
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2529
Mailing Address - Country:US
Mailing Address - Phone:804-616-7219
Mailing Address - Fax:
Practice Address - Street 1:7300 HANOVER GREEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1705
Practice Address - Country:US
Practice Address - Phone:804-616-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717002160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist