Provider Demographics
NPI:1851837587
Name:MCKENNA, CASEY (MS, CGC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BUCKINGHAM CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2908
Mailing Address - Country:US
Mailing Address - Phone:800-975-4819
Mailing Address - Fax:800-930-0961
Practice Address - Street 1:360 CENTRAL AVE
Practice Address - Street 2:SUITE 1230
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3857
Practice Address - Country:US
Practice Address - Phone:800-975-4819
Practice Address - Fax:800-930-0961
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS