Provider Demographics
NPI:1952593261
Name:MCKOY, COSTELLA MARIE ROBERTS (LPC)
Entity type:Individual
Prefix:MRS
First Name:COSTELLA
Middle Name:MARIE ROBERTS
Last Name:MCKOY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1394
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28370-1394
Mailing Address - Country:US
Mailing Address - Phone:910-295-5580
Mailing Address - Fax:910-692-3573
Practice Address - Street 1:10 PARKER LN
Practice Address - Street 2:SUITE 2
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7903
Practice Address - Country:US
Practice Address - Phone:910-638-5966
Practice Address - Fax:910-692-3573
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional