Provider Demographics
NPI:1154876027
Name:MCKENZIE, DONNESHA (LCSWA)
Entity type:Individual
Prefix:
First Name:DONNESHA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 HAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5352
Mailing Address - Country:US
Mailing Address - Phone:910-483-5986
Mailing Address - Fax:910-483-2876
Practice Address - Street 1:907 HAY ST STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5352
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:910-483-2876
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2022-10-24
Deactivation Date:2020-02-19
Deactivation Code:
Reactivation Date:2020-03-18
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24729101YA0400X
NCP0106101041C0700X
NCP0170801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)