Provider Demographics
NPI:1578658696
Name:MCKINLEY, VIRGINIA MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:MARIE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PUEBLO TRL
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-9757
Mailing Address - Country:US
Mailing Address - Phone:505-437-2304
Mailing Address - Fax:
Practice Address - Street 1:49 MDOS/SGOH
Practice Address - Street 2:200 FIRST STREET
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330
Practice Address - Country:US
Practice Address - Phone:505-572-5676
Practice Address - Fax:505-572-2126
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3011741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical