Provider Demographics
NPI:1205133386
Name:KINNAN, TINA MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:KINNAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:LONG-WINEMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1200 SE MAYNARD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6937
Mailing Address - Country:US
Mailing Address - Phone:919-636-0762
Mailing Address - Fax:513-826-9314
Practice Address - Street 1:1200 SE MAYNARD RD STE 103
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6937
Practice Address - Country:US
Practice Address - Phone:919-636-0762
Practice Address - Fax:513-826-9314
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500705101YP2500X
NC11331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional