Provider Demographics
NPI:1770107971
Name:MCKINSTRY, ROBERT L
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:MCKINSTRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7046 MARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3577
Mailing Address - Country:US
Mailing Address - Phone:704-806-3161
Mailing Address - Fax:
Practice Address - Street 1:7046 MARKWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3577
Practice Address - Country:US
Practice Address - Phone:704-806-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC523140106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician