Provider Demographics
NPI:1710572565
Name:MCCOY, KENISHA ELISE (MA, EDS)
Entity Type:Individual
Prefix:MRS
First Name:KENISHA
Middle Name:ELISE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GRANTHAM CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1547
Mailing Address - Country:US
Mailing Address - Phone:757-572-0959
Mailing Address - Fax:
Practice Address - Street 1:236 MUSTANG TRL STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7517
Practice Address - Country:US
Practice Address - Phone:757-340-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health