Healthcare Provider Details

I. General information

NPI: 1629516075
Provider Name (Legal Business Name): NAKUNDA MCCOY EVERETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 US 70 HWY W
GARNER NC
27529-2501
US

IV. Provider business mailing address

1027 US 70 HWY W
GARNER NC
27529-2501
US

V. Phone/Fax

Practice location:
  • Phone: 845-476-7080
  • Fax:
Mailing address:
  • Phone: 845-476-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04378
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPO11374
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: