Healthcare Provider Details

I. General information

NPI: 1942997986
Provider Name (Legal Business Name): KIYEKA GIFT MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WESTERN BLVD STE Q
JACKSONVILLE NC
28546-6852
US

IV. Provider business mailing address

111 GREENBRIAR DR
JACKSONVILLE NC
28546-7204
US

V. Phone/Fax

Practice location:
  • Phone: 910-858-5848
  • Fax:
Mailing address:
  • Phone: 910-787-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019667
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: