Provider Demographics
NPI:1831541382
Name:MCKINNON, JANICE CAROL (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:CAROL
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 LUCKY LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1788
Mailing Address - Country:US
Mailing Address - Phone:410-802-8636
Mailing Address - Fax:
Practice Address - Street 1:679 LUCKY LEAF CIR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1788
Practice Address - Country:US
Practice Address - Phone:410-802-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD046301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical