Provider Demographics
NPI:1447135272
Name:ATHERALL, MACKENNA (LCSW)
Entity type:Individual
Prefix:
First Name:MACKENNA
Middle Name:
Last Name:ATHERALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 3RD ST APT UNITD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4414
Mailing Address - Country:US
Mailing Address - Phone:516-287-4260
Mailing Address - Fax:
Practice Address - Street 1:743 3RD ST APT D
Practice Address - Street 2:743 3RD ST APT D
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:516-287-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1304691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical