MEDICARE: LAKENYA HOLMES MCCALLISTER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629196779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKENYA HOLMES MCCALLISTER LCSW

Provider Business Mailing Address
First Line	:	1395 N COURTENAY PKWY STE 207
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4475
Country	:	US
Telephone Number	:	321-514-0371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 N COURTENAY PKWY STE 207
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4475
Country	:	US
Telephone Number	:	321-394-8701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	03/03/2025

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