Provider Demographics
NPI:1063072080
Name:MCKENZIE, BROOKE ELIZABETH (LMSW, QIDP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMSW, QIDP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:LAMPHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW, QIDP
Mailing Address - Street 1:4069 POSTAL DR PO BOX 20156
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:269-270-4875
Mailing Address - Fax:
Practice Address - Street 1:4069 POSTAL DR PO BOX 20156
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:269-270-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011154191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical