Provider Demographics
NPI:1184693707
Name:MCKINNEY, ASHLEY ANGLISS (LPA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ANGLISS
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WILSON DR STE 5
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8782
Mailing Address - Country:US
Mailing Address - Phone:828-268-2172
Mailing Address - Fax:877-211-7323
Practice Address - Street 1:249 WILSON DR STE 5
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8782
Practice Address - Country:US
Practice Address - Phone:828-268-2172
Practice Address - Fax:877-211-7323
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2555103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046UXOtherBCBS
NCN/AOtherCAROLINA BEHAVIORAL HEALT
NC6107381Medicaid