Provider Demographics
NPI:1144209826
Name:MCCANN, JINA VINCENT BRADFORD
Entity Type:Individual
Prefix:MS
First Name:JINA
Middle Name:VINCENT BRADFORD
Last Name:MCCANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 LYNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1404
Mailing Address - Country:US
Mailing Address - Phone:617-901-6292
Mailing Address - Fax:
Practice Address - Street 1:8501 TANNER WILLIAMS RD
Practice Address - Street 2:AVIATION TRAINING CENTER MOBILE
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-8322
Practice Address - Country:US
Practice Address - Phone:251-441-6725
Practice Address - Fax:251-441-6415
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MN275991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other