MEDICARE: MACKENZIE MEGAN THOMAS MSW, LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P014251	NC
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1710256797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE MEGAN THOMAS MSW, LCSWA

Provider Business Mailing Address
First Line	:	4521 BRIARGLEN LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9264
Country	:	US
Telephone Number	:	910-309-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 BRIARGLEN LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9264
Country	:	US
Telephone Number	:	910-309-5277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	03/30/2023

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