Provider Demographics
NPI:1346512878
Name:MCKINNEY, DIANNA S (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:S
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:SUE
Other - Last Name:PENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW, LICDC
Mailing Address - Street 1:5837 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2923
Mailing Address - Country:US
Mailing Address - Phone:513-541-7577
Mailing Address - Fax:513-541-4555
Practice Address - Street 1:5837 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2923
Practice Address - Country:US
Practice Address - Phone:513-541-7577
Practice Address - Fax:513-541-4555
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161433101YA0400X
OHI. 16007961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)