Provider Demographics
NPI:1518192061
Name:LEWIS, MACKENZIE KING (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:KING
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WALDEN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8664
Mailing Address - Country:US
Mailing Address - Phone:252-227-9346
Mailing Address - Fax:
Practice Address - Street 1:203 WALDEN WOODS DR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-8664
Practice Address - Country:US
Practice Address - Phone:252-227-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist