Provider Demographics
NPI:1194378836
Name:MCKINNEY, CANDICE T (LPC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:T
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 ROGER BACON DR STE 5
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5202
Mailing Address - Country:US
Mailing Address - Phone:703-261-9201
Mailing Address - Fax:703-995-4642
Practice Address - Street 1:11250 ROGER BACON DRIVE
Practice Address - Street 2:ATRIUM #5
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-2019
Practice Address - Country:US
Practice Address - Phone:703-261-9201
Practice Address - Fax:703-995-4642
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional