Provider Demographics
NPI:1205347630
Name:MCKINNON, CAROLINE R (PHD, PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:R
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:PHD, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 LAMBETH DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4272
Mailing Address - Country:US
Mailing Address - Phone:706-721-6779
Mailing Address - Fax:
Practice Address - Street 1:688 LAMBETH DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4272
Practice Address - Country:US
Practice Address - Phone:706-721-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186809163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health