Provider Demographics
NPI:1184452476
Name:MCKINNEY, REBECCA NAOMI VIRGINIA (ALC, NCC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NAOMI VIRGINIA
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:ALC, NCC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:NAOMI VIRGINIA
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5231 DREW RUN
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1153
Mailing Address - Country:US
Mailing Address - Phone:765-461-5679
Mailing Address - Fax:
Practice Address - Street 1:129 N CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1376
Practice Address - Country:US
Practice Address - Phone:205-207-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health