Provider Demographics
NPI:1104871078
Name:MCKAY, JEFFREY (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MCKAY
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:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-0814
Mailing Address - Country:US
Mailing Address - Phone:336-495-2700
Mailing Address - Fax:
Practice Address - Street 1:287 EAST STREET
Practice Address - Street 2:SUITE 421
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8637
Practice Address - Country:US
Practice Address - Phone:919-542-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106038Medicaid
NC2874520,AMedicare ID - Type Unspecified