Provider Demographics
NPI:1336660489
Name:MCKINNEY, CLOVER CASSIDY (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:CLOVER
Middle Name:CASSIDY
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:RAY
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCAS
Mailing Address - Street 1:502 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:336-693-4086
Mailing Address - Fax:
Practice Address - Street 1:3643 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2702
Practice Address - Country:US
Practice Address - Phone:919-470-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0117161041C0700X
NCCO123571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical