Provider Demographics
NPI:1013464353
Name:MCKOY, RICK (LPCA)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:MCKOY
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:RICKEY
Other - Middle Name:LANE
Other - Last Name:MCKOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:180 MEADOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7936
Mailing Address - Country:US
Mailing Address - Phone:919-818-4371
Mailing Address - Fax:
Practice Address - Street 1:180 MEADOW GLEN DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7936
Practice Address - Country:US
Practice Address - Phone:919-818-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional