Provider Demographics
NPI:1811869639
Name:BEAVER, MCKENZIE GOLD
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:GOLD
Last Name:BEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 NC HWY 49 N # 1001
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28137-7942
Mailing Address - Country:US
Mailing Address - Phone:704-456-9465
Mailing Address - Fax:
Practice Address - Street 1:212 NC HWY 49 N # 1001
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:NC
Practice Address - Zip Code:28137-7942
Practice Address - Country:US
Practice Address - Phone:704-456-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-24-359255106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician