Provider Demographics
NPI:1275060444
Name:MCKIVER, BRIONNA (LCSWA)
Entity Type:Individual
Prefix:
First Name:BRIONNA
Middle Name:
Last Name:MCKIVER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:BRIONNA
Other - Middle Name:
Other - Last Name:MCKIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:2935 BREEZEWOOD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5498
Mailing Address - Country:US
Mailing Address - Phone:910-491-1758
Mailing Address - Fax:
Practice Address - Street 1:2935 BREEZEWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5498
Practice Address - Country:US
Practice Address - Phone:910-491-1758
Practice Address - Fax:910-491-1887
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0154161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty