Individual
MRS. LISA W MCKINNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
5202 BLOSSOM HILL DR, HAYMARKET, VA 20169-3161
(904) 874-4163
Mailing address
7001 HERITAGE VILLAGE PLZ, SUITE 230, GAINESVILLE, VA 20155-3065
(904) 874-4163
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT1822
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0717001294
VA THERAPY LICENSE
VA
Enumeration date
10/10/2011
Last updated
07/30/2015
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