Provider Demographics
NPI:1033490669
Name:MACKENZIE, CARLA GENEVIEVE (LCAS, LCSWA)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:GENEVIEVE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LCAS, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7045
Mailing Address - Country:US
Mailing Address - Phone:910-796-6868
Mailing Address - Fax:910-796-6869
Practice Address - Street 1:5013 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7045
Practice Address - Country:US
Practice Address - Phone:910-796-6868
Practice Address - Fax:910-796-6869
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NCP0057681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)