Mikenzie McKimmie, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018601 Issued in NC

Practice address

2935 Breezewood Ave Ste 103
Fayetteville, NC 28303-5498

Phone

(910) 491-1758

NPI assigned

Jan 19, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Second Chance Counseling Services, PLLC

  • Clinical Social Worker
  • Fayetteville, NC
  • NPI 1801308143
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1674086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1972218444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2935 BREEZEWOOD AVE STE 103",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035498",
            "telephone_number": "910-491-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 BREEZEWOOD AVE STE 103",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035498",
            "telephone_number": "910-491-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIMMIE",
        "first_name": "MIKENZIE",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donnesha McKenzie, LCSWA
• Savannah McKenzie
• Te'Cara McKenzie
• Darius McKethan
• Doressia McKethan
• Elizabeth A McKinley, MS, CCC-SLP
• Kyle Patrick McKinley, DO
• Carolyn Elise Pockat McKinney, DPT
• Jessica McKinney
• Stephanie Bourne McKithan, FNP-C, APRN, DNP

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.