Provider Demographics
NPI:1801595178
Name:MCCOY, RALPH KENNETH JR (BA QMHP-A QIDP/QDDP)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:KENNETH
Last Name:MCCOY
Suffix:JR
Gender:M
Credentials:BA QMHP-A QIDP/QDDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 NASHUA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-7622
Mailing Address - Country:US
Mailing Address - Phone:267-709-1186
Mailing Address - Fax:
Practice Address - Street 1:8119 NASHUA DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-7622
Practice Address - Country:US
Practice Address - Phone:267-709-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11469079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health