Provider Demographics
NPI:1457771123
Name:MCKINNEY, KELLIE O'LEARY (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:O'LEARY
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4234
Mailing Address - Country:US
Mailing Address - Phone:410-585-4525
Mailing Address - Fax:
Practice Address - Street 1:2401 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1517
Practice Address - Country:US
Practice Address - Phone:410-675-2113
Practice Address - Fax:410-675-2115
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional