Provider Demographics
NPI:1043205073
Name:MCKINLEY, KAREN L (PSY D LCSW LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PSY D LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 ACADEMY AVE
Mailing Address - Street 2:ACADEMY CROSSING MEDICAL PLAZA
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3205
Mailing Address - Country:US
Mailing Address - Phone:757-483-6404
Mailing Address - Fax:757-483-0737
Practice Address - Street 1:3300 ACADEMY AVE
Practice Address - Street 2:ACADEMY CROSSING MEDICAL PLAZA
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3205
Practice Address - Country:US
Practice Address - Phone:757-483-6404
Practice Address - Fax:757-483-0737
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000070101YA0400X
VA09040000791041C0700X
VA0717000902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA08072SOtherSENTARA
VA8902976Medicaid
VA090573OtherANTHEM
VA08072SOtherSENTARA
VA80000032SMedicare PIN