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NPI Code Detail

MEDICARE: MACKENZIE TOLAND LBA, BCBA, LMFT

MEDICARE: MACKENZIE TOLAND LBA, BCBA, LMFT
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
1106H00000XMarriage & Family Therapist
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1871909101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE TOLAND LBA, BCBA, LMFT
Provider Business Mailing Address
First Line : 920 CAMBRIDGE ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-5300
Country : US
Telephone Number : 910-493-3555
Fax Number : 910-493-3520
Provider Business Practice Location Address
First Line : 920 CAMBRIDGE ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-5300
Country : US
Telephone Number : 910-493-3555
Fax Number : 910-493-3520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2014
Last Update Date : 05/15/2024

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