Provider Demographics
NPI:1720675168
Name:MCKINNEY-STEGE, LECRESHIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LECRESHIA
Middle Name:
Last Name:MCKINNEY-STEGE
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 1:122 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1925
Mailing Address - Country:US
Mailing Address - Phone:734-945-6210
Mailing Address - Fax:
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1929
Practice Address - Country:US
Practice Address - Phone:734-945-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2021-04-23
Deactivation Date:2021-01-15
Deactivation Code:
Reactivation Date:2021-02-11
Provider Licenses
StateLicense IDTaxonomies
MI6301018387103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling