Provider Demographics
NPI:1427441591
Name:MCKINZIE, MICHELLE HEATHER (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HEATHER
Last Name:MCKINZIE
Suffix:
Gender:F
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 2145
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-2145
Mailing Address - Country:US
Mailing Address - Phone:828-772-0470
Mailing Address - Fax:828-579-2740
Practice Address - Street 1:1045 BEECH RIDGE TRL UNIT 102
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-0441
Practice Address - Country:US
Practice Address - Phone:828-772-0470
Practice Address - Fax:828-579-2740
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0084321041C0700X
NCC0097911041C0700X
TNLSW00000069741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical