Provider Demographics
NPI:1184396624
Name:MCKINSTRY, DAMEKA LESHELL (LSW)
Entity type:Individual
Prefix:
First Name:DAMEKA
Middle Name:LESHELL
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3470
Mailing Address - Country:US
Mailing Address - Phone:419-779-0414
Mailing Address - Fax:
Practice Address - Street 1:1219 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5836
Practice Address - Country:US
Practice Address - Phone:567-289-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005678104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker