Provider Demographics
NPI:1811376965
Name:MCKENZIE, SORADO (MQMHP,MSAC,LCASA)
Entity Type:Individual
Prefix:MR
First Name:SORADO
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MQMHP,MSAC,LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S SKIPPER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3843
Mailing Address - Country:US
Mailing Address - Phone:336-404-2110
Mailing Address - Fax:
Practice Address - Street 1:205 S SKIPPER ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3843
Practice Address - Country:US
Practice Address - Phone:336-404-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2827-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)