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General NPI Number Information
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NPI Number | 1407605611
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Entity Type | Individual
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Provider Name | ELIZA MACKNIGHT LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 7000 HARPS MILL RD STE 202
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City | RALEIGH
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State | NC
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Zip | 27615-3241
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Country | US
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Telephone | 984-225-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 159 STALLINGS MILL LOOP APT 201
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City | CLAYTON
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State | NC
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Zip | 27520-3101
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Country | US
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Telephone | 434-806-3608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MACK-96WXCH
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License Number State | NC
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