Provider Demographics
NPI:1508318015
Name:MCKINNEY, DORIS (EDD,LPC,MA,LBSW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:EDD,LPC,MA,LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 LAWTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3323
Mailing Address - Country:US
Mailing Address - Phone:313-345-4665
Mailing Address - Fax:313-345-4885
Practice Address - Street 1:16600 LAWTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3323
Practice Address - Country:US
Practice Address - Phone:313-345-4665
Practice Address - Fax:313-345-4885
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6820010461041C0700X
MI6401003073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical