Provider Demographics
NPI:1609352780
Name:MCKINNEY, DESHARA (LMSW)
Entity Type:Individual
Prefix:
First Name:DESHARA
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 LOUISE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1650
Mailing Address - Country:US
Mailing Address - Phone:734-366-0879
Mailing Address - Fax:
Practice Address - Street 1:106 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2367
Practice Address - Country:US
Practice Address - Phone:734-649-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011160821041C0700X
MI6801101839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker