Provider Demographics
NPI:1649412883
Name:MCKNIGHT, DENNIS LEE (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:LEE
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509A W FRIENDLY AVE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4269
Mailing Address - Country:US
Mailing Address - Phone:336-297-1060
Mailing Address - Fax:336-323-1691
Practice Address - Street 1:5509A W FRIENDLY AVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4269
Practice Address - Country:US
Practice Address - Phone:336-297-1060
Practice Address - Fax:336-323-1691
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1366103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical