Provider Demographics
NPI:1811475205
Name:WILLIAM T. MCKENNA, LLC
Entity type:Organization
Organization Name:WILLIAM T. MCKENNA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:804-264-0966
Mailing Address - Street 1:5821 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5427
Mailing Address - Country:US
Mailing Address - Phone:804-264-0966
Mailing Address - Fax:804-264-1029
Practice Address - Street 1:5821 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5427
Practice Address - Country:US
Practice Address - Phone:804-264-0966
Practice Address - Fax:804-264-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty