Provider Demographics
NPI:1649269739
Name:MCKENNEY, ANGELA (LCSW, LADC, MHRTC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:LCSW, LADC, MHRTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TOGUS 1 VA CTR
Mailing Address - Street 2:116-B
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-6142
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:
Practice Address - Street 1:TOGUS 1 VA CTR
Practice Address - Street 2:116-B
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-6142
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC3232101YA0400X
MELC4596101YA0400X
MEMC124231041C0700X
MELC139321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5410480099Medicaid