Provider Demographics
NPI:1952630220
Name:CASAD, MCKENZIE D (MSW,LCSW, CD)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:D
Last Name:CASAD
Suffix:
Gender:F
Credentials:MSW,LCSW, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 TOWLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-3234
Mailing Address - Country:US
Mailing Address - Phone:757-553-2780
Mailing Address - Fax:
Practice Address - Street 1:2117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4527
Practice Address - Country:US
Practice Address - Phone:757-553-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VA09040069401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical