Provider Demographics
NPI:1508209529
Name:MCINNIS, CAROL LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEIGH
Last Name:MCINNIS
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 1:301 FORT LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2221
Mailing Address - Country:US
Mailing Address - Phone:757-391-5928
Mailing Address - Fax:757-391-6535
Practice Address - Street 1:301 FORT LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2221
Practice Address - Country:US
Practice Address - Phone:757-391-5928
Practice Address - Fax:757-391-6535
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional