Provider Demographics
NPI:1972820256
Name:MCKENZIE, HEATHER MARIE (MS, LCMHCS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MS, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 PENNCROSS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2177
Mailing Address - Country:US
Mailing Address - Phone:919-744-8335
Mailing Address - Fax:
Practice Address - Street 1:3434 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 135 - 535
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27518-2278
Practice Address - Country:US
Practice Address - Phone:919-744-8335
Practice Address - Fax:844-644-3163
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104500Medicaid