MEDICARE: MRS. NAKUNDA MCCOY EVERETT LCSWA

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	1041C0700X	Clinical Social Worker	PO11374	NC
2	1041C0700X	Clinical Social Worker	CSW04378	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO11374	OTHER	NC	NORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD

General Provider Information

NPI Number	:	1629516075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAKUNDA MCCOY EVERETT LCSWA

Provider Business Mailing Address
First Line	:	60 BUCKLEIGH DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-6612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 BUCKLEIGH DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-6612
Country	:	US
Telephone Number	:	919-625-5118
Fax Number	:

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

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/05/2026

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