Provider Demographics
NPI:1144637851
Name:GUTHRIE, MIKE ROCKY JR (LCSW)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:ROCKY
Last Name:GUTHRIE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8120
Mailing Address - Country:US
Mailing Address - Phone:828-808-0220
Mailing Address - Fax:
Practice Address - Street 1:2068 SE NORTH BLACKWELL DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7040
Practice Address - Country:US
Practice Address - Phone:828-808-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0103351041C0700X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool