Provider Demographics
NPI:1356745509
Name:MCCOY, ROSANNA (LCADC)
Entity type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:MRS
Other - First Name:ROSANNA
Other - Middle Name:RENEE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0730
Mailing Address - Country:US
Mailing Address - Phone:606-874-0240
Mailing Address - Fax:606-874-8666
Practice Address - Street 1:105 TRIMBLE CHAPEL SQUARE
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-874-0240
Practice Address - Fax:606-874-8666
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1207101YA0400X
KY164694101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)