Individual
BIANCA MCKINNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4622 W FREMONT RD, LAVEEN, AZ 85339-4277
(480) 335-4134
Mailing address
4622 W FREMONT RD, LAVEEN, AZ 85339-4277
(480) 335-4134
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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