Provider Demographics
NPI:1588036362
Name:JOHNSON, MCKENZIE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:MCKENZIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:MISS
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:4304 SIR JULIAN CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-8717
Mailing Address - Country:US
Mailing Address - Phone:984-920-2866
Mailing Address - Fax:
Practice Address - Street 1:4304 SIR JULIAN CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-8717
Practice Address - Country:US
Practice Address - Phone:984-920-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11790101YM0800X, 101YP2500X
NCA11790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional