Provider Demographics
NPI:1528275641
Name:MCKINNEY, MARCUS MICHAEL (DMIN, LPC)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:MICHAEL
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2357
Mailing Address - Country:US
Mailing Address - Phone:860-644-8723
Mailing Address - Fax:
Practice Address - Street 1:65 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2357
Practice Address - Country:US
Practice Address - Phone:860-644-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional