Individual provider Active NPI

Lakenya Holmes McCallister, LCSW

  • Clinical Social Worker
  • Merritt Island, FL
National Provider Identifier
1629196779
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1395 N Courtenay Pkwy Ste 207
Merritt Island, FL 32953-4475
Phone
(321) 394-8701
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

1395 N Courtenay Pkwy Ste 207
Merritt Island, FL 32953-4475

Mailing address

1395 N Courtenay Pkwy Ste 207
Merritt Island, FL 32953-4475
Phone (321) 514-0371

Other practice location 1

115 N Lafayette St
Suite 4
Shelby, NC 28150-4482
Phone (225) 733-0498

Other practice location 2

640 Brevard Ave
Suite 104
Cocoa, FL 32792-2541
Phone (321) 514-0371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1629196779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 N COURTENAY PKWY STE 207",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534475",
            "telephone_number": "321-514-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 N COURTENAY PKWY STE 207",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534475",
            "telephone_number": "321-394-8701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 N Lafayette St",
            "address_2": "Suite 4",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "NC",
            "postal_code": "281504482",
            "country_code": "US",
            "telephone_number": "225-733-0498",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Brevard Ave",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Cocoa",
            "state": "FL",
            "postal_code": "327922541",
            "country_code": "US",
            "telephone_number": "321-514-0371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCALLISTER",
        "first_name": "LAKENYA",
        "middle_name": "HOLMES",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.