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General NPI Number Information
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NPI Number | 1679422802
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Entity Type | Individual
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Provider Name | MACKENZIE LAUREN BOYLES LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 714 CAROLINA AVE STE A
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City | YADKINVILLE
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State | NC
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Zip | 27055-7793
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Country | US
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Telephone | 336-818-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 115 MILLSEAT DR
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City | ARARAT
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State | NC
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Zip | 27007-8170
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Country | US
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Telephone | 336-710-8565
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A22417
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License Number State | NC
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