Healthcare Provider Details

I. General information

NPI: 1194407163
Provider Name (Legal Business Name): LAMESHA MCKENZIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR
LAUREL MD
20708-3287
US

IV. Provider business mailing address

PO BOX 2116
DOTHAN AL
36302-2116
US

V. Phone/Fax

Practice location:
  • Phone: 334-798-8282
  • Fax:
Mailing address:
  • Phone: 334-798-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3909G
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200002638
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: