Provider Demographics
NPI:1265730261
Name:MCKINNEY, MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LINNAEUS PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5416
Mailing Address - Country:US
Mailing Address - Phone:919-969-2616
Mailing Address - Fax:
Practice Address - Street 1:1506 E FRANKLIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2825
Practice Address - Country:US
Practice Address - Phone:919-969-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045TEOtherBLUE CROSS/BLUE SHIELD