Provider Demographics
NPI:1780625061
Name:MCKINNISH, SUSAN CONARD (MSW,LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CONARD
Last Name:MCKINNISH
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MONTGOMERY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-5715
Mailing Address - Country:US
Mailing Address - Phone:828-454-0901
Mailing Address - Fax:828-454-0901
Practice Address - Street 1:56 MONTGOMERY ST
Practice Address - Street 2:SUITE D
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-5715
Practice Address - Country:US
Practice Address - Phone:828-454-0901
Practice Address - Fax:828-454-0901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002255Medicaid
NC130JJOtherBLUE CROSS BLUE SHEILD
NC130JJOtherBLUE CROSS BLUE SHEILD