Provider Demographics
NPI:1407605611
Name:MACKNIGHT, ELIZA (LCMHCA)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:MACKNIGHT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 STALLINGS MILL LOOP APT 201
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3101
Mailing Address - Country:US
Mailing Address - Phone:434-806-3608
Mailing Address - Fax:
Practice Address - Street 1:7000 HARPS MILL RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3241
Practice Address - Country:US
Practice Address - Phone:984-225-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMACK-96WXCH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health