Provider Demographics
NPI:1891055752
Name:MCKOY, ANITA MATTHEWS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MATTHEWS
Last Name:MCKOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-9752
Mailing Address - Country:US
Mailing Address - Phone:910-890-6823
Mailing Address - Fax:
Practice Address - Street 1:317 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4801
Practice Address - Country:US
Practice Address - Phone:919-777-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC00018581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical