Provider Demographics
NPI:1831656602
Name:MCKINNIE, MILLIE (RADTI)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:
Last Name:MCKINNIE
Suffix:
Gender:F
Credentials:RADTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 CLAIREMONT MESA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1127
Mailing Address - Country:US
Mailing Address - Phone:858-715-1211
Mailing Address - Fax:858-715-1274
Practice Address - Street 1:8898 CLAIREMONT MESA BLVD STE H
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1127
Practice Address - Country:US
Practice Address - Phone:858-715-1211
Practice Address - Fax:858-715-1274
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)