Provider Demographics
NPI:1730229147
Name:MACKE, WILLIAM E (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:MACKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2403
Mailing Address - Country:US
Mailing Address - Phone:678-326-4618
Mailing Address - Fax:770-252-7513
Practice Address - Street 1:1665 HIGHWAY 34 E
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2403
Practice Address - Country:US
Practice Address - Phone:678-326-4618
Practice Address - Fax:770-252-7513
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3974104100000X
GACSW0049581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical