Healthcare Provider Details

I. General information

NPI: 1750111233
Provider Name (Legal Business Name): MS. CHRISTINE MARGARET MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 APPLEWOOD WAY
TALLAHASSEE FL
32312-6780
US

IV. Provider business mailing address

1505 APPLEWOOD WAY
TALLAHASSEE FL
32312-6780
US

V. Phone/Fax

Practice location:
  • Phone: 850-933-2759
  • Fax:
Mailing address:
  • Phone: 850-933-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1144270
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26099
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW012027
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6903C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: