Provider Demographics
NPI:1114398740
Name:MCKANE, COURTNEY (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:MCKANE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 E HARRISON CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1906
Mailing Address - Country:US
Mailing Address - Phone:540-226-4627
Mailing Address - Fax:
Practice Address - Street 1:1101 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5457
Practice Address - Country:US
Practice Address - Phone:540-371-1124
Practice Address - Fax:540-371-9038
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health