Provider Demographics
NPI:1861618100
Name:MCKINNEY, MARY (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 STATE FARM RD
Mailing Address - Street 2:SUITE 304, BOX #4
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4914
Mailing Address - Country:US
Mailing Address - Phone:828-268-0155
Mailing Address - Fax:
Practice Address - Street 1:805 STATE FARM RD
Practice Address - Street 2:SUITE 304, BOX #4
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4914
Practice Address - Country:US
Practice Address - Phone:828-268-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist